Longitudinal Trajectories of Engagement With HIV Treatment Support Strategies Among Female Sex Workers Living With HIV in South Africa

Background: – Tailored implementation strategies to promote the uptake and scale-up of antiretroviral therapy (ART) among female sex workers (FSWs) in South Africa are needed, because <50% of FSW living with HIV are on ART and <40% are virally suppressed.Setting: – We conducted a randomized trial testing 2 HIV treatment support strategies (decentralized treatment provision; individualized case management) among 777 FSW living with HIV and not virally suppressed (≥50 copies/mL) in Durban, South Africa, June 2018–January 2022.Methods: – We defined strategy engagement in a 6-month interval if the monthly strategy session was delivered and the FSW participated. Group-based trajectory modeling with logit response function was used to identify engagement trajectories and describe correlates of trajectories. We used Poisson regression analysis with robust variance estimation to assess the association between assigned trajectory group and 18-month retention and viral suppression (<50 copies/mL).Results: – We identified 4 trajectories: no engagement (12%), late engagement (10%), engagement corresponding with study visits (53%), and consistent engagement (25%). FSW who were older, unmarried, receiving ART at enrollment, and decentralized treatment provision assignment were more likely to be classified in the consistently engaged trajectory compared with the no engagement trajectory. The prevalence of 18-month retention and viral suppression was higher among FSW assigned to the consistent engagement trajectory than FSW assigned to the no engagement trajectory (prevalence ratio = 3.2, 95% confidence interval: 1.6 to 6.3).Conclusions: – Person-centered HIV services that address unmet treatment needs could improve health, viral suppression, and subsequently reduce population-level HIV transmission.Clinical trial registration: – NCT03500172.