Exploring the context and role of quality of care on HIV outcomes among female sex workers in the Dominican Republic
Karver, Tahilin Sanchez
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Female sex workers (FSWs) experience a substantially disproportionate burden of HIV. In the Dominican Republic (DR), FSWs have nearly five times greater odds to be living with HIV compared to other adults. Despite interventions focusing on facilitating FSWs’ engagement in the HIV care continuum, ART adherence and viral suppression remain sub-optimal. It is thus important to assess the contributing role of quality of HIV care on HIV outcomes and explore the mechanisms for improving this care as a means to address FSWs’ pathway to viral suppression. Thematic analysis was used to explore the dynamics contributing to the quality of HIV care among FSWs living in the DR using two rounds of in-depth interviews (IDIs) (n=20 per round) and clinic assessments (n=11). Next, drawing from survey data (n=211), multivariable logistic regressions were used to explore the associations between select individual, provider and clinic level factors, and ART adherence and viral suppression. Lastly, the role of peer navigation in enhancing the quality of HIV care was explored via IDIs and survey data. Results highlighted the influence of treatment literacy, relational aspects of the HIV care experience, availability of resources, and the cost of care on the quality of HIV care experienced by FSWs. Significant associations were found between treatment literacy and ART adherence and viral suppression, while positive patient-provider communication and respectful treatment were significantly associated with being virally suppressed. Cost of care was negatively associated with ART adherence and viral suppression. Peer navigation and support was found to positively enhance the quality of HIV services by promoting linkage and retention in care, respectful treatment, greater access to comprehensive care, and contributing to increasing FSWs’ agency in the clinic environment. Ultimately, peer navigation was linked to increased satisfaction with HIV services and was recommended by FSWs as a mechanism to improve HIV care among FSWs. Findings from this study enhance the understanding of the context and association between HIV care and positive HIV outcomes, including ART adherence and viral suppression, among FSWs. Results highlight areas for programmatic investments to promote effective HIV treatment and care programs targeting key populations disproportionately affected by HIV.