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Retention in HIV Care Among Female Sex Workers in the Dominican Republic: Implications for Research, Policy and Programming

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Abstract

There are clear benefits of retention in HIV care, yet millions of people living with HIV are sub-optimally retained. This study described factors from Andersen’s behavioral model that were associated with retention in HIV care among 268 female sex workers (FSWs) living with HIV in the Dominican Republic using two measures of retention: a 6-month measure of HIV clinic attendance and a measure that combined clinic attendance and missed visits. FSWs who ever attended HIV care reported high rates (92 %) of 6-month attendance, but 37 % reported missed visits. Using the combined retention measure, the odds of being retained in HIV care were higher among FSWs with more positive perceptions of HIV service providers [adjusted odds ratio (AOR) 1.17; 95 % confidence interval (CI) 01.09, 1.25] and lower among women who reported recent alcohol consumption (AOR 0.50; 95 % CI 0.28, 0.92) and self-stigmatizing beliefs related to sex work (AOR 0.93; 95 % CI 0.88, 0.98). These findings support the hypothesis that retention in HIV care may be best determined through a combined measure as missed visits are an important mechanism to identify in-care patients who require additional support.

Resumen

Hay claros beneficios de la retención en la atención del VIH; sin embargo, millones de personas que viven con el VIH tienen retención sub-óptima. Este estudio describe los factores del Modelo de Comportamiento de Andersen asociados con la retención en la atención del VIH entre 268 trabajadoras sexuales (TRSX) que viven con el VIH en la República Dominicana. Se utilizó dos variables de retención: un variable fue la asistencia a una clínica de VIH en los últimos seis meses y en el otro se combinó asistencia a la clínica junto con citas perdidas. Las TRSX que habían asistidas a la clínica por lo menos una vez tuvieron altas tasas de la asistencia en los últimos seis meses (92 %), aunque el 37 % reportaron visitas perdidas. La probabilidad de ser retenida en la atención, según el variable combinado, fue mayor entre las TRSX con mejores percepciones de los proveedores de servicios de VIH (Razón de posibilidades ajustada [RPA]: 1,17; 95 % intervalo de confianza [IC]: 01.09, 1.25) y menor entre las mujeres que reportaron consumo de alcohol reciente (RPA: 0,50; IC del 95 %: 0,28, 0,92) y el estigma internalizado relacionado al trabajo sexual (RPA: 0,93; IC del 95 %: 0,88, 0,98). Estos resultados sostienen la hipótesis de que la retención en la atención del VIH puede ser mejor determinado a través de una definición combinada ya que las visitas pérdidas son un mecanismo importante para identificar a los pacientes que requieren apoyo adicional.

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Acknowledgments

We would like to thank the study participants for their active participation along with our partners, MODEMU and COIN. We would also like to acknowledge Dr. Caitlin Kennedy and Dr. Chris Beyrer for their careful review of the article.

Financial Support

The study was funded by the US Agency for International Development (http://www.usaid.gov/) under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The funders had no role in study design, data collection and analysis, or manuscript preparation.

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 904, Baltimore, MD, 21205, USA

    Rose Zulliger, Cathy Maulsby, David Holtgrave & Deanna Kerrigan

  2. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Clare Barrington

  3. HIV Vaccine Research Unit, Instituto Dermatalogico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic

    Yeycy Donastorg & Martha Perez

Authors
  1. Rose Zulliger
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  2. Cathy Maulsby
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  3. Clare Barrington
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  4. David Holtgrave
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  5. Yeycy Donastorg
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  6. Martha Perez
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  7. Deanna Kerrigan
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Corresponding author

Correspondence to Rose Zulliger.

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Zulliger, R., Maulsby, C., Barrington, C. et al. Retention in HIV Care Among Female Sex Workers in the Dominican Republic: Implications for Research, Policy and Programming. AIDS Behav 19, 715–722 (2015). https://doi.org/10.1007/s10461-014-0979-5

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  • DOI: https://doi.org/10.1007/s10461-014-0979-5

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