1. Tom Ellman, Southern Africa Medical Unit, MSF
Community-based testing strategies among sex workers in a transport corridor in Mozambique
Tom Ellman, Southern Africa Medical Unit, MSF

2. Conflict of Interest
No conflicts of interest to declare

3. Background and Methods
JUST SAY IT….LONG-STANDING PROGRAMME WITH CROSS-BORDER AND MIGRANT SWS.
OUTREACH AND PEER-;LED SERVICES LINKING AND TESTING.,
RETRO ANALYSIS OF ROUTINE DATA AMONG ENTRANTS JAN 2014 TO FEB 2016 WITH 6 MNTH F/U- MEASURED PREV, RETESTING IN NEGS.
ALSO quali study of SWPE perceptions re their role

4. Results- 1
2654 SW enrolled
1781 tested
338 self-report positive
535 status unknown
Median age at first contact of 27 years [23-32]
Overall HIV positivity was 53%
About 45% of positive were aware of their positive status.
Note high rates of incidence and unaware in youngest….

5. Results- 2
39% of HIV-negative SWs retested at least once within 6 months
18 (5%) seroconverted within 6 months
High LTFU but majority who stayed agreed to test at least once in the period…..not enough but….
SWPEs described their ability to reach out to their peers, to engage new and 'informal' SWs with health-care services, including HIV testing
Challenges included experiencing prejudice and undervaluation by non-SW colleagues””quote”” “They don’t realize, but the reason we work here, is for them to be able to do their work.”
C 15% incidence across tete and beira among repeat testers….larger cohort longer period…

6. Discussion High rate of testing among retained SW with SWPE support
High mobility and loss to follow-up
Difficult to manage cohort M&E routinely at community level
PREP to prevent HIV and to promote re-testing
Stigma and low status undermine SWPE role:
Greater efforts are needed to develop SWPE role within SW programs.
Including support to testing and PREP
Acceptance of testing was high
Among negatives only 39% re-tested within 6 months
Incidence was high
Must let swpe do the testing. Train em up. Leadership???
Overall….messages are that this is a willing high-risk pop BUT mobility and stigma make access difficult. Community-based M&E also tricky for cohort under routine conditions. SWPE huge potential but underused (testing) and undervalued. Diff care…. Incentives to return…PREP seem to work too.
PREP found that >70% still testing at 6 months and 80% at 3.

7. Muito obrigado!