Public Health Thesis Defense, Alexandra Bitty-Anderson

The PAC-CI PROGRAM extends its heartfelt congratulations to Dr. Alexandra Bitty-Anderson, MPH (Ivory Coast), on earning her doctorate (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
: Epidemics of HIV, STIs, and viral hepatitis are a major public health problem, especially in sub-Saharan Africa, which has the highest number of people affected.Among key populations—that is, groups that, due to certain behaviors specific to them, are more vulnerable to certain diseases—these epidemics are even more severe. It is estimated that female sex workers (FSWs) are 26 times more likely to become infected with HIV than women in the general population, and that two-thirds 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 improving care for sex workers by focusing on describing these epidemics and the challenges they face in accessing health services. To this end, during the research for this public health dissertation, we analyzed data from a national survey of key populations in Togo and a cross-sectional survey of sex workers. Using these data sources, we estimated the prevalence of HIV and viral hepatitis B and C among sex workers, estimated the prevalence of certain STIs, and described healthcare utilization among HIV-positive sex workers. Our results show a high prevalence of HIV among sex workers—four times higher than that observed among women in the general population. We also report the 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 sex workers had been vaccinated against hepatitis B. Among STIs, infection with T. vaginalis was the most common. Nearly half of the sex workers had experienced symptoms of STIs in the previous year, with abnormal vaginal discharge and vaginal itching being the most common symptoms. An assessment of the care continuum among HIV-positive sex workers showed that 91.1% of sex workers knew their HIV status; half of them (50.0%) were on antiretroviral therapy, and among those on therapy, 68.9% had viral suppression. In conclusion, this dissertation has provided new epidemiological data on the epidemics of HIV, viral hepatitis, and STIs among sex workers in Togo. These results should serve as a basis for addressing the many challenges in the management of HIV, viral hepatitis, and STIs among sex workers in Togo and the subregion