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Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters\u2019 Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load \u22651000 copies\/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention\u2019s implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe\u2019s changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.<\/jats:p>","DOI":"10.1093\/heapol\/czz037","type":"journal-article","created":{"date-parts":[[2019,5,27]],"date-time":"2019-05-27T15:13:06Z","timestamp":1558969986000},"page":"337-345","source":"Crossref","is-referenced-by-count":20,"title":["Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial"],"prefix":"10.1093","volume":"34","author":[{"given":"Joanna","family":"Busza","sequence":"first","affiliation":[{"name":"Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarisai","family":"Chiyaka","sequence":"first","affiliation":[{"name":"Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sithembile","family":"Musemburi","sequence":"first","affiliation":[{"name":"Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Fearon","sequence":"first","affiliation":[{"name":"Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calum","family":"Davey","sequence":"first","affiliation":[{"name":"Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungai","family":"Chabata","sequence":"first","affiliation":[{"name":"Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillis","family":"Mushati","sequence":"first","affiliation":[{"name":"Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Dirawo","sequence":"first","affiliation":[{"name":"Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Napierala","sequence":"first","affiliation":[{"name":"RTI International, 351 California Street, Suite 500, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew N","family":"Phillips","sequence":"first","affiliation":[{"name":"Institute for Global Health, UCL, Royal Free Hospital, Rowland Hill Street, London, UK and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances M","family":"Cowan","sequence":"first","affiliation":[{"name":"Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe"},{"name":"Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R","family":"Hargreaves","sequence":"first","affiliation":[{"name":"Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,3]]},"reference":[{"key":"2020060220100823400_czz037-B1","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1089\/apc.2010.0349","article-title":"Peer health workers and AIDS care in Rakai, Uganda: a mixed methods operations research evaluation of a cluster-randomized trial","volume":"25","author":"Arem","year":"2011","journal-title":"AIDS Patient Care and STDs"},{"key":"2020060220100823400_czz037-B2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1080\/09540121.2010.498868","article-title":"Confronting structural violence in sex work: lessons from a community-led HIV prevention project in Mysore, India","volume":"23","author":"Argento","year":"2011","journal-title":"AIDS Care"},{"key":"2020060220100823400_czz037-B3","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S1473-3099(12)70066-X","article-title":"Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis","volume":"12","author":"Baral","year":"2012","journal-title":"The Lancet. 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