Quantitative and Biological survey of sexual health needs of female sex workers reached by two NGOs in Côte d'Ivoire (ANRS 12361 PrEP-CI)

Study setting

The ANRS 12361 PrEP-CI cross-sectional study was designed and implemented with two Ivorian community-based organizations between September 2016 and March 2017. Aprosam works within the city of San Pedro and in the surrounding areas, particularly in villages close to farming businesses (coffee and cocoa exploitation). Espace Confiance operates in several districts of Abidjan, the economic capital of Côte d’Ivoire (Koumassi, Marcory, Treichville, Zone 4 and Port-Bouët with its beaches). Both of these nongovernmental organizations (NGOs) deliver HIV prevention and testing services directly at prostitution sites (outreach activities) and provide HIV and SRH care services through a community clinic, for FSWs.

Survey

From October 2016 to January 2017, a convenient sample of 1000 FSWs completed a 45-item standardized paper questionnaire that assessed their sociodemographic characteristics (age, nationality, level of education, number of children), their sexual practices and behaviors (duration and location of sex work, usual price of sexual intercourses, condom use with clients and regular partners, assault/coerced sexual intercourse), their knowledge and use of community health services (medical consultations, hepatitis B immunization, declared STIs, sex work during menstruations, use and knowledge of contraception, undesired pregnancies, abortion), a priori acceptability of a PrEP (pre-exposure prophylaxis) offer (perception of the risk to contract HIV, knowledge of any medicine (traditional or modern) to prevent HIV infection, interest in a modern medicine for HIV prevention, acceptance of a medical follow-up every three months), HIV infection (HIV testing, knowledge of HIV status of the regular partner).

The purpose of the quantitative study was not to be representative of all FSWs in Côte d’Ivoire but rather to represent FSWs who could be reached by the two partner NGOs and who could potentially benefit from PrEP in a future program. Therefore, the eligibility criteria for the quantitative survey included being 18 years or older, working at a prostitution site at the time of the survey, and never being tested for HIV or previously testing HIV-negative, as we performed a test to determine how many women were exposed to HIV and not diagnosed. FSWs visiting community clinics of the two NGOs for an HIV test were also included.

Recruitment of participants for this study was made possible by the Aprosam and Espace Confiance organizations’ networks of peer educators and their access to the population. Peer educators enrolled FSWs who met eligibility criteria and agreed to participate, after reading an information sheet and signing a consent form. They carried out data collection in dedicated health centres and prostitution sites during face-to-face interviews.

HIV screening and laboratory analysis 

HIV screening was carried out by two rapid tests (Determine®, Alere and Vikia®, bioMérieux) at the sex work sites. In the event of a positive result, HIV infection was confirmed by a rapid test (stat-pack®). Then, a dried blood spot (DBS) sample was taken and transported to the laboratory of the University Hospital of Tours, France, to determine the window of infection and false positive rate using a recent infection test adapted to the Ivorian context and performed directly on plasma. This recent infection test made it possible to classify HIV infections into two groups: HIV infections contracted less than 6 months prior and those contracted more than 6 months prior.

During the study, FSW diagnosed with HIV infection were referred to community clinics by peer educators for ART.

Ethical considerations

Research authorizations were obtained from the National Committee of Research Ethics within the Ivorian Ministry of Health and Public Hygiene (reference number: 057/MSHP/CNER-kp, delivered on June 28, 2016). Confidentiality was maintained, and data were anonymized. Informed consent was obtained by the investigator before each interview or questionnaire.