Table 1.
Research Agenda for Sex Workers and HIV
| Question | Study | Comments |
|---|---|---|
| Epidemiology | ||
|
| ||
| How prevalent is HIV in SW? How common is undiagnosed HIV infection? | HIV seroprevalence and testing surveys | Must be voluntary, use newer methods (RDS, VTS) |
|
| ||
| What is HIV incidence in SW? | Cross-sectional or prospective studies | Next generation recency assays |
|
| ||
| Basic Sciences | ||
|
| ||
| What formulations of vaginal and rectal microbicides will be acceptable, safe, and efficacious for SW? | Phase I and II trials need to include SW in sufficient sample size for stratified analyses | |
| What new oral/injectable PrEP agents will be acceptable, safe, and efficacious for SW? | Phase I and II trials need to include SW of all genders | |
|
| ||
| Promoting Optimal Care | ||
|
| ||
| How do we optimize access to care for SW? | Continuum of Care and implementation science studies for SW | Stand alone vs integrated services, community led vs community engaged |
| Stigma reduction interventions in health care settings | ||
| Novel adherence studies | Community mobilization interventions could be adapted to adherence support | |
| Human Rights: Impact on successful prevention and treatment | Integration of violence, discrimination, and other human rights measures into SW studies | Violence and broader dimensions of trauma shown to compromise adherence and treatment responses |
| Trauma-informed care | ||
|
| ||
| HIV Prevention | ||
|
| ||
| What combinations of HIV preventive interventions will reduce HIV incidence for SW? | Testing feasibility, acceptability, of prevention packages, trials of efficacy | Resources for SW specific RCTs may be limited |
| What are the best methods to assess combination prevention? | Modeling studies, community-participatory research | |
| What new interventions may hold promise for SW? | Next generation HIV vaccines | Planned WRAIR trial will study MSM in Thailand, may include MSW, TGSW |
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| ||
| Structural Change | ||
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| ||
| Structural interventions can reduce HIV risks and increase HIV access for SW? | Structural determinants (risks and protective) studies | Many studies may not have HIV outcomes, but measure changes in violence, safety, access to care |
| Ending impunity for crimes and abuses | Impact of decriminalization on health outcomes | Little is known about changing contexts of impunity to accountability |
| Police, violence prevention, community empowerment interventions | ||