Theme: Models of Care Year: 2022
Background:
Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and syphilis are
highly prevalent and treatable sexually transmitted infections (STIs) among female sex workers
(FSWs). Traditionally, the management of STIs in FSWs is carried out by laboratory-based diagnoses
and treated at healthcare centers. This has led to underdiagnosis, treatment delay, overuse of
presumptive treatment and loss of follow-up. This new model of care is set out to engage and
optimize the diagnosis, treatment, and care of STIs among street based FSWs by using point-of-care
nucleic acid amplification test (NAAT) and same day treatment based on results at a mobile unit
(MU).
Description of model of care/intervention:
A MU was used to screen CT, NG and TV using a NAAT on self-collected urine samples, and the FSWs
could receive results-based treatment at the same day. Further, HIV, hepatitis C (HCV) and syphilis
were screened using rapid tests. The results are delivered in 90 minutes (CT/NG) and 40-65 minutes
(TV). Participants with positive results were offered free-of charge treatment based on results,
prescribed and administrated by a medical team at the MU. FSWs refusing treatment was
encouraged to attend an STIs clinic.
Effectiveness:
In a pilot study of 49 FSW, we found that the prevalence of CT/NG/TV and syphilis was 15.6%, 13.0%,
45.5% and 16.7%, respectively, 63.2% of whom were asymptomatic. The use of drugs was associated
with a higher likelihood of having at least one STI. Forty-eight participants received STI treatment.
Three patients had HIV antibodies and seven had positive HCV antibodies (three viremics).
Conclusion and next steps:
This model is rapid and simple, allowing engagement in care and treatment for a majority of FSWs.
FSWs who use drugs have higher risk of STIs. This strategy could help to mitigate the transmission of
STIs and identify opportunities for HIV PrEP.
Disclosures:
JV acknowledges speaker fees from Gilead Sciences, AbbVie and ViiV, outside the submitted work.
PR acknowledges grants, personal fees and non-financial support from Gilead Sciences and Merck,
personal fees from VIIV and personal fees and non-financial support from AbbVie, outside the
submitted work. JVL acknowledges a grant from AbbVie to ISGlobal to fund this study, grants and
speaker fees from Gilead Sciences and MSD and speaker fees from AbbVie, Genfit, Intercept and
ViiV, outside the submitted work. GC, LV, JTM, LJ, JD and MC have nothing to disclose.