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 PROGRAM 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.
Topic: Epidemiology of sexually transmitted infections among sex workers in Togo.
Abstract
The epidemics of HIV, STIs, and viral hepatitis are a significant public health issue, particularly in sub-Saharan Africa, which has the highest number of affected individuals. Among key populations—those more vulnerable to certain diseases due to specific behaviors—these epidemics are even more pronounced. Sex workers (SWs) are estimated to have 26 times the risk of HIV infection compared to women in the general population, and two-thirds of them have a treatable STI at any given time. However, a lack of data hinders an effective response. The objective of this thesis was to contribute to the improved care of SWs by focusing on the description of these epidemics and the challenges of accessing healthcare services. For this purpose, during the research for this public health thesis, we analyzed data from a national survey of key populations in Togo and a cross-sectional survey of SWs. Using these data sources, we estimated the prevalence of HIV and viral hepatitis B and C among SWs, estimated the prevalence of certain STIs, and described the use of healthcare services by HIV-positive SWs. Our results report a high prevalence of HIV among SWs, four times higher than that observed in the general female population. We also report a persistence of risky behaviors, such as inconsistent condom use. The prevalence of viral hepatitis was high but comparable to that of the general population; however, 2.7% of HIV-positive SWs had been vaccinated against hepatitis B. For STIs, infection by T. vaginalis was the most frequent. Nearly half of the SWs had presented symptoms of an STI in the previous year, with abnormal vaginal discharge and vaginal itching being the most common symptoms. The evaluation of the care cascade among HIV-positive SWs showed that 91.1% of SWs knew their serological status, half of them (50.0%) were on antiretroviral treatment, and among those on treatment, 68.9% had a suppressed viral load. In conclusion, this thesis provided new epidemiological data on HIV, viral hepatitis, and STI epidemics among SWs in Togo. These results should serve as a basis for addressing the numerous challenges of HIV, viral hepatitis, and STI care among SWs in Togo and the sub-region.
