Population Council Knowledge Commons HIV and AIDS Social and Behavioral Science Research (SBSR) 1-1-2021 Assessment of community-based ART service model linking female sex workers to HIV care and treatment in Blantyre and Mangochi, Malawi Lung Vu Population Council Brady Zieman Population Council Adamson Muula Vincent Samuel Lyson Tenthani Population Council See next page for additional authors Follow this and additional works at: https://knowledgecommons.popcouncil.org/departments_sbsr-hiv Part of the Public Health Commons How does access to this work benefit ou?y Let us know! Recommended Citation Vu, Lung, Brady Zieman, Adamson Muula, Vincent Samuel, Lyson Tenthani, David Chilongozi, Simon Sikwese, Grace Kumwenda, and Scott Geibel. 2021. "Assessment of community-based ART service model linking female sex workers to HIV care and treatment in Blantyre and Mangochi, Malawi," Project SOAR Final Report. Washington, DC: USAID | Project SOAR. This Report is brought to you for free and open access by the Population Council. Authors Lung Vu, Brady Zieman, Adamson Muula, Vincent Samuel, Lyson Tenthani, David Chilongozi, Simon Sikwese, Grace Kumwenda, and Scott Geibel This report is available at Knowledge Commons: https://knowledgecommons.popcouncil.org/departments_sbsr-hiv/ 551 Assessment of Community-based ART Service Model Linking Female Sex report Workers to HIV Care and Treatment in Blantyre and Mangochi, Malawi Lung Vu Brady Zieman Adamson Muula Vincent Samuel Lyson Tenthani David Chilongozi Simon Sikwese Grace Kumwenda JANUARY 2021 JANUARY Scott Geibel Project SOAR Population Council 4301 Connecticut Ave, NW, Suite 280 Washington, D.C. 20008 USA Tel: +1 202 237 9400 Fax: +1 202 237 8410 projsoar.org Project SOAR (Cooperative Agreement AID-OAA-A-14-00060) is made possible by the generous support of the American people through the United States President’s Emergency Plan for AIDS Relief and the United States Agency for International Development (USAID). The contents of this report are the sole responsibility of Project SOAR and the Population Council and do not necessarily reflect the views of PEPFAR, USAID, or the United States Government. Through operations research, Project SOAR will determine how best to address challenges and gaps that remain in the delivery of HIV and AIDS care and support, treatment, and prevention services. Project SOAR will produce a large, multifaceted body of high-quality evidence to guide the planning and implementation of HIV and AIDS programs and policies. Led by the Population Council, Project SOAR is implemented in collaboration with Avenir Health, Elizabeth Glaser Pediatric AIDS Foundation, Johns Hopkins University, Palladium, and The University of North Carolina. The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science and public health research in about 50 countries, the Council works with our partners to deliver solutions that lead to more effective policies, programs, and technologies to improve lives worldwide. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization with an international board of trustees. Cover photo credit: ©Brian Dell Published in January 2021. ©2021 The Population Council Inc. Suggested citation: Vu, Lung, Brady Zieman, Adamson Muula, Vincent Samuel, Lyson Tenthani, David Chilongozi, Simon Sikwese, Grace Kumwenda, Scott Geibel. 2020. “Assessment of community-based ART service model linking female sex workers to HIV care and treatment in Blantyre and Mangochi, Malawi,” Project SOAR Final Report. Washington, DC: USAID | Project SOAR. Assessment of Community-based ART Service Model Linking Female Sex Workers to HIV Care and Treatment in Blantyre and Mangochi, Malawi Lung Vu,1 Brady Zieman,1 Adamson Muula,2 Vincent Samuel,2 Lyson Tenthani,1 David Chilongozi,3 Simon Sikwese,4 Grace Kumwenda,4 Scott Geibel1 1Population Council, Washington, DC 2University of Malawi, College of Medicine, Malawi 3FHI 360, Malawi 4Pakachere, Malawi ACKNOWLEDGMENTS We greatly appreciate the collaboration with our LINKAGES and Pakachere colleagues who implemented the study, especially the DIC clinicians, counselors, and peer educators who led the implementation of the pilot and provided critical support during two rounds of data collection. We would like to acknowledge the hard work of the field research coordinators Laura Moyo and Dukuma Kalua from College of Medicine, University of Malawi. This study would not be possible without the support of Ministry of Health, which provided support, recommendations, and government buy-in for this study. Lastly, we would like to thank the study participants for their willingness to participate and lead the way for the future of ART in Malawi. ii ■ Community-based ART service model linking FSWs to HIV care and treatment in Blantyre and Mangochi, Malawi TABLE OF CONTENTS ACKNOWLEDGMENTS ................................................................................................................II ACRONYMS ................................................................................................................................IV EXECUTIVE SUMMARY ..............................................................................................................1 INTRODUCTION...........................................................................................................................5 METHODOLOGY ..........................................................................................................................7 Objectives ................................................................................................................................................ 7 Study design ............................................................................................................................................ 7 Description of intervention ..................................................................................................................... 8 Data collection methods .......................................................................................................................10 Ethical review.........................................................................................................................................12 Data analysis ........................................................................................................................................12 KEY FINDINGS ......................................................................................................................... 13 Recruitment ...........................................................................................................................................13 Basic characteristics at baseline (n=193) ..........................................................................................13 Comparisons of those retained and those lost to follow-up ...............................................................14 Comparison of population by modality at HIV care and treatment registration ...............................15 ART outcomes by preferred modality ...................................................................................................18 Experiences of violence .......................................................................................................................20 Depression and suicidal ideation.........................................................................................................20 Internalized stigma................................................................................................................................20 Perceived externalized stigma ..............................................................................................................21 Comparison of sexual risk behaviors over time ..................................................................................21 Qualitative findings................................................................................................................................22 DISCUSSION ........................................................................................................................... 25 Limitations .............................................................................................................................................27 CONCLUSION AND RECOMMENDATIONS.............................................................................. 28 REFERENCES ......................................................................................................................... 30 Community-based ART service model linking FSWs to HIV care and treatment in Blantyre and Mangochi, Malawi ■ iii ACRONYMS AIDS Acquired immune deficiency syndrome ART Antiretroviral therapy DIC Drop-in center FSW Female sex worker GBV Gender-based violence HIV Human immunodeficiency virus LINKAGES Linkages across the Continuum of HIV Services for Key Populations Affected by HIV MOH Ministry of Health MOHSW Ministry of Health and Social Welfare MSM Men who have sex with men NACP National AIDS Control Programme PLHIV People living with HIV PEPFAR President’s Emergency Plan for AIDS Relief STI Sexually transmitted infection TB Tuberculosis USAID United States Agency for International Development WHO World Health Organization VL Viral load iv ■ Community-based