HIV Prevention and Treatment Cascades Among Female Sex Workers in Benin, West Africa.

BACKGROUND: Benin has a long-standing history of HIV prevention programs aimed at female sex workers (FSWs). We used data from a national survey among FSWs (2017) to assess the prevention and care cascades in this population. METHODS: Female sex workers were recruited through cluster sampling of sex work sites. A questionnaire was administered, and HIV tested. HIV-positive participants were asked to provide dried blood spots and were tested for antiretroviral and viral load. We assessed 2 prevention cascades (HIV testing and safer sex) and the treatment cascade, using a combination of self-reported and biological variables. RESULTS: Mean age of the 1086 FSWs was 30 years. Half of them were Beninese, and two-thirds had a primary school education level or less. Almost all FSWs had ever heard of HIV/AIDS. More than half (79.1%) had ever been tested, and 84.1% of the latter had been tested in the last year. In the previous 6 months, 90.1% were exposed to prevention messages. Women exposed to any HIV prevention message reported a higher level of consistent condom use in the last month (69.0%) than those who were not (48.5%, P < 0.0001). HIV prevalence was 7.7%. Among HIV-positive women, 60.6% knew their status; among those, 90.5% were on antiretroviral and 81.8% of them had a suppressed viral load. CONCLUSIONS: Despite long-standing HIV prevention programs for FSWs, the prevention indicators were often low. Linkage to care was good, viral suppression was suboptimal, but knowledge of HIV-positive status was low. Exposing women to prevention messages is necessary, as to increase HIV testing.

[Seroprevalence of viral hepatitis B and its associated factors determined based on data from a screening campaign targeting the general population in Benin]. / Hépatite virale B lors d´une campagne de dépistage en population générale au Bénin: séroprévalence et facteurs associés.

INTRODUCTION: hepatitis B is a global public health problem. The purpose of this study was to determine the prevalence of hepatitis B virus (HBV) and its associated factors based on data from a mass screening in several localities across Benin. METHOD: we conducted a cross-sectional descriptive and analytical study with prospective data collection. Data collection was carried out during voluntary free hepatitis B screening organized by the Rotary Club in 23 localities across Benin from the 20th to 28th July 2019. Rapid test for diagnostic orientation was used for the detection of HBs antigen. RESULTS: a total of 9035 volunteers were included in the study. They were mostly of Benin origin (99%), with a mean age of 27 years; 51.1% of them were singles, mainly schoolchildren, pupils or students (37.9%). HBV seroprevalence was 6% (545/9035) [95%CI=5.5%-6.5%]. In univariate analysis, factors associated with HBs Ag colonization were: age, sex, marital status, education level, occupation and a history of diabetes, scarification and hepatitis C, while in multivariate analysis they were: sex, age and education level. CONCLUSION: HBV seroprevalence is 6% in the study population. HBV infection mainly affects male subjects over 17 years of age with secondary-level education.

HIV treatment response among female sex workers participating in a treatment as prevention demonstration project in Cotonou, Benin.

OBJECTIVES: Female sex workers (FSWs) play a key role in HIV transmission in West Africa, while they have limited access to antiretroviral therapy (ART). In line with UNAIDS recommendations extending ART to all HIV-infected individuals, we conducted this demonstration project on immediate treatment as prevention (TasP) among FSWs in Cotonou, Benin. We report data on treatment response and its relation to adherence, as well as on ART-resistant genotypes. METHODS: Complete follow-up varied between 12 and 24 months. At each three-monthly visit, a questionnaire was administered, clinical examinations were carried out and blood samples collected. Adherence to treatment was estimated by self-report. Viral RNA was genotyped at baseline and final visits for drug resistance. Generalized estimating equations for repeated measures with a log-binomial link were used to analyze time trends and the association between adherence and virological response to treatment. RESULTS: One-hundred-seven HIV-positive and ART-naive FSWs were enrolled; 59.8% remained in the cohort till study completion and 62.6% had a final visit. Viral load<1000 (below quantification limit [<50]) was attained in 73.1% (64.6%) of participants at month-6, 84.8% (71.2%) at month-12, and 80.9% (65.1%) at the final visit. The proportion of women with suppressed (below quantification limit) viral load increased with increasing self-reported adherence (p = 0.06 (0.003), tests for trend). The proportion of participants with CD4≤500 also decreased drastically throughout follow-up (p < .0001). Twelve participants exhibited ART-resistant genotypes at baseline, but only two at their final visit. CONCLUSION: Our findings indicate that TasP is widely accepted among FSWs in Cotonou and could be implemented with relative success. However, due to mobility in this population, follow-up was sub-optimal, suggesting that large geographical coverage of FSW-friendly clinics is needed for sustained treatment implementation. We also fell short of the UNAIDS objective of 90% viral suppression among treated patients, underlining the need for better adherence support programs.