Summary & Key Points
"The PAC-CI PROGRAMME extends its warmest congratulations to Dr. Alexandra Bitty-Anderson, MPH (Côte d'Ivoire) for obtaining her PhD in Public Health, which she defended on December 7, 2022, at the University of Bordeaux."
The PAC-CI PROGRAMME extends its warmest congratulations to Dr. Alexandra Bitty-Anderson, MPH (Côte d’Ivoire), on the successful defense of her Doctor of Philosophy (PhD) in Public Health on December 7, 2022, at the University of Bordeaux.
Thesis topic: Epidemiology of sexually transmitted infections among female sex workers in Togo.
Abstract
HIV, STI, and viral hepatitis epidemics pose a major public health challenge, particularly in sub-Saharan Africa, which bears the highest burden of affected individuals. Key populations—groups that, due to specific behaviors, face heightened vulnerability to certain diseases—experience even greater impacts. Female sex workers (FSWs) are estimated to be 26 times more likely to contract HIV than women in the general population, and two-thirds have a treatable STI at any given time. However, a lack of data hinders effective responses. This thesis aimed to improve FSW care by focusing on describing these epidemics and the challenges in accessing health services. To achieve this, we analyzed data from a national survey of key populations in Togo and a cross-sectional survey of FSWs. Using these datasets, we estimated the prevalence of HIV and viral hepatitis B and C among FSWs, assessed the prevalence of certain STIs, and described healthcare utilization among HIV-positive FSWs. Our findings reveal a high HIV prevalence among FSWs—four times higher than in the general female population—and persistent risky behaviors, such as inconsistent condom use. While viral hepatitis prevalence was high, it was comparable to that of the general population; however, only 2.7% of HIV-positive FSWs had been vaccinated against hepatitis B. Among STIs, *Trichomonas vaginalis* was the most common. Nearly half of FSWs reported STI symptoms in the past year, with abnormal vaginal discharge and itching being the most frequent. The HIV care cascade evaluation showed that 91.1% of FSWs knew their HIV status, half (50.0%) were on antiretroviral therapy, and of those, 68.9% had a suppressed viral load. In conclusion, this thesis provides new epidemiological data on HIV, viral hepatitis, and STI epidemics among FSWs in Togo. These findings should serve as a foundation for addressing the many challenges in managing HIV, viral hepatitis, and STIs among FSWs in Togo and the broader subregion.
