Evaluating the Impact of a Peer Navigation Programme on Viral Suppression Among Female Sex Workers in Bulawayo, Zimbabwe: A 24-Month Cohort Analysis

Female sex workers in Zimbabwe face significant barriers to HIV care, leading to suboptimal viral suppression rates. Peer navigation programmes are a potential intervention, but longitudinal evidence of their sustained impact is limited. This study evaluated the impact of the 'Sisters with a Voice' peer navigation programme on achieving and maintaining viral load suppression among female sex workers living with HIV in Bulawayo, Zimbabwe, over 24 months. A prospective cohort survey was conducted with 350 female sex workers newly enrolled in the programme. Viral load data were collected at baseline, 12 months, and 24 months via clinical record abstraction and structured interviews. The primary outcome was the proportion of participants with a suppressed viral load (<1000 copies/mL) at each interval. Viral suppression increased significantly from 42% at baseline to 78% at 12 months and was sustained at 76% at 24 months. Qualitative data indicated that consistent, non-judgemental peer support was key to mitigating stigma and improving clinic attendance. The peer navigation programme was associated with a substantial and sustained improvement in viral suppression among this cohort over two years. Peer navigation should be integrated as a core component of differentiated HIV service delivery for female sex workers in comparable settings. Programmes require sustained funding and formal linkages to public health facilities to ensure longevity. HIV, viral suppression, female sex workers, peer navigation, Zimbabwe, key populations This research provides longitudinal evidence on the effectiveness of a community-led peer navigation model in sustaining HIV treatment success among a marginalised population.