Background In Guatemala, female sex workers (FSWs) have historically demonstrated a high HIV prevalence and are considered a key group in heterosexual HIV transmission. A system for sentinel surveillance of HIV-STI infection, risk behaviours and STI control targeting FSW, incorporating prevention components (VICITS) was rolled at public health centres in four Guatemalan cities, beginning in 2007, 2008, 2010 and 2011, respectively. We present the first assessment of scale-up, retention and HIV-STI infection trends among VICITS users.

Methods The number of FSW accessing VICITS each year in 2007–2011 was estimated by health centre based on a unique, person-level identifier. Retention was estimated as the percent of new users accessing VICITS in a given year who returned for at least one control visit. Percent of users infected was estimated from regular, quarterly exams, taking into account exams realised during each period for syphilis, gonorrhoea and Chlamydia, and up to and including each period for HIV.

Results Overall, the number of FSW accessing VICITS annually increased from 555 to 2557 (361%) during the period. At the longest running sites (1 and 2), a plateau or decline of up to 13% annually was observed after year 3 (2010 and 2011, respectively). In parallel, retention rates declined from 51% to 41% at site 1 (2007–2011), from 72% to 41% at site 2 (2008–2011), and increased from 14% to 35% at site 3 (2010–2011). HIV prevalence varied from 0.6% to 4.8% and prevalence of Chlamydia, the most common STI, from 1.9% to 8.5%, with differences across sites but not over time.

Conclusions VICITS achieved rapid scale-up and has identified local differences in relatively stable infection prevalence that can help to prioritise prevention programming among FSW. However, a better understanding of the causes of low follow-up by new users is needed to improve interpretation of surveillance findings.