A realist-informed evaluation of the implementation of complex HIV treatment support strategies for female sex workers living with HIV
An article in Annals of Epidemiology, published September 2025
Authors: Carly A Comins, Mfezi Mcingana, Becky Genberg, Ntambue Mulumba, Elvin Geng, Sharmistha Mishra, Deliwe R. Phetlhu, Sita Lujintanon, Lily Shipp, Joel Steingo, Harry Hausler, Stefan Baral, Sheree Schwartz
The Siyaphambili trial in South Africa aimed to improve health outcomes for female sex workers (FSW) living with HIV by testing two different strategies to help them achieve better viral suppression. The researchers wanted to understand which conditions made these strategies appropriate, feasible, and effective, and whether they were implemented correctly.
The study found that the success of the strategies depended on several factors. The appropriateness of the strategies was influenced by whether they met the specific needs of the FSW. The feasibility of implementing the strategies depended on the availability of resources, work infrastructure, and access to necessary information. The fidelity of implementation, or how well the strategies were applied as intended, relied on strong partnerships, effective communication, and the ability to adapt the strategies to fit different situations. Finally, the effectiveness of the strategies was influenced by the capability of the FSW to take advantage of them, which depended on their motivation and opportunities. The study concluded that understanding these conditions can help in designing better strategies to improve treatment outcomes for FSW living with HIV.