Alida Ngwije is working on a cohort of female sex workers (FSW) recruited from Kigali city by the Project San Francisco (PSF) in Rwanda. In Rwanda, female sex workers count for 42% of the national HIV prevalence, are the most exposed group to HIV, and prevalent spreaders of the epidemic in the population. The cohort is subdivided into two groups: FSW who are HIV negative at the time of enrollment - who are followed to capture and study HIV acute infection as soon as it occurs; and FSW who are positive at the time of enrollment and are followed up to assess the treatment response, virus suppression and study HIV drug resistance. Although anti-retroviral treatment has been widely made available in Rwanda, especially with the implementation of test and treat strategies, some subjects remain with more than a thousand copies of viral load after being on treatment for at least six months. This study is among the firsts to gather reliable data on the magnitude of this issue in the country.
The first objective of the study is to identify HIV infection as early as possible and to understand the virus pattern in the early stages of the infection. The second objective is to assess HIV drug resistance in HIV infected FSW without viral suppression after being on treatment for at least six months. Specialised tests - such as gene expert testing for HIV acute infection and genotyping testing - will be used to assess whether the lack of suppression could be linked to new strains that are resistant to available HIV treatment, which are circulated by FSW, and present a great challenge to existing efforts to fight the epidemic in the country.