Background: Female sex workers (FSW) are often poorly engaged with HIV prevention and care. We conducted a cluster-randomized trial of combination prevention to empower female sex workers (''SAPPH-IRe'') embedded within Zimbabwe''s National FSW Program (''Sisters'').
Methods: We randomly allocated 14 clusters in matched-pairs to ''usual care'' (Sisters) or to SAPPH-IRe. A cluster was defined as the FSW population working around a clinic providing the services listed below.
Usual care Sisters'' program: sex-worker friendly services, free HIV testing, referral to government health services for ART, contraception, condoms, STI syndromic management, health education and legal advice; all supported by peer educators.
SAPPH-IRe: the usual-care Sisters program plus intensified community mobilization; provision of onsite ART; SMS reminders to promote repeat testing for HIV-ve, pre-exposure prophylaxis for HIV-ve, and community-based adherence support to build a ''sisterhood'' to improve engagement with intensified prevention and care.
The primary outcome was the proportion of all FSW with detectable viral load (VL>1000 copies/ml) after 21 months.
A baseline survey was completed in November 2013 (n=2722 FSW, 57.5% HIV-positive, 50.5% HIV-positive and with viral load>1000 copies /ml) and a separate endline survey in April 2016, both using respondent-driven sampling. Recruitment to the surveys was not linked to participation in the interventions since the aim was to assess the population impact of SAPPH-Ire. Pre-specified analyses are underway. Secondary outcome and process data were also collected.
Results: The SAPPH-IRe intervention was implemented from May 2014 to March 2016. The Table compares program activity by arm. 2,883 FSWs participated in the endline survey, providing questionnaire data and dried-blood spot (n=2876) for HIV antibody and viral load testing which is now complete.

 SAPPH-IRe sitesUsual Care Sisters sites
# community mobilisation meetings537145
# peer educator contacts17,01313,151
# FSW seen4,5493,574
# FSW clinic attendances12,90510,031
# HIV tests26061,151
# ART on-site initations7680
# on-site PrEP initiations4870
# Adherence sisters paid5140
[Program data May 2014 - Mar 2016]

Conclusions: The SAPPH-IRe intervention resulted in increased program activity and provided on-site ART and PrEP. The endline results to be reported at conference will tell us the community level impact on the proportion of FSW with viral load >1000 copies/ml.