Loss of follow-up among HIV infected female sex workers receiving antiretrovirals in Dakar, Senegal

Abstract

A better understanding of the significance and determinants of loss of follow-up and key potential related 
outcome measures, such as death and missed study visit would assist program evaluation and provide basis 
for future interventions. Senegal has one of Africa’s lowest HIV/AIDS infection rate, less than 1%. But 
vulnerable groups such as sex workers have higher HIV prevalence. Currently, HIV infection among legal sex 
workers in Dakar has risen to 27.1%, compared to 1% 20 years ago, (Fact sheet, 2004). The prostitution in 
Senegal has been regulated since 1969. Sex workers register at public health clinics like ours, where they 
receive photo identity cards and make monthly visits for medical checkups. However, many operate outside the 
system. We estimate that more than 80% of Senegal sex workers do not register. In a retrospective cohort 
analysis, loss of follow-rates and death were assessed among HIV infected female sex workers receiving 
antiretroviral drugs at the “Institute d'Hygiene Social” (IHS) of Dakar, Senegal. Records of 74 HIV infected 
female sex workers receiving antiretroviral treatment, and followed at the IHS from April 2001 to August 2008 
were reviewed. Overall, 15 patients (20.3%) died and 42 (57%) were lost during an average follow-up period of 
26 months (SD = 18.9). The mean age of patients was 46.6 years old (SD = 7.8) and the mean CD4 count at entry 
was 215 (SD = 68.6). Using Cox Regression models, we did not find a significant relationship between age, 
ethnicity, CD4 count at entry or HIV-1 vs. HIV-2 type and loss of follow-up. These findings indicate the need to 
obtain better longitudinal follow-up data for optimal assessment of the reasons for loss-of follow up among HIV 
infected female sex workers receiving ARV in Senegal.