A retrospective cross sectional study assessing factors associated with retention and non-viral suppression among HIV positive FSWs receiving antiretroviral therapy from primary health care facilities in Kampala, Uganda

(2022) 22:642 Atuhaire et al. BMC Infectious Diseases https://doi.org/10.1186/s12879-022-07614-w Open Access RESEARCH A retrospective cross sectional study assessing factors associated with retention and non‑viral suppression among HIV positive FSWs receiving antiretroviral therapy from primary health care facilities in Kampala, Uganda Lydia Atuhaire1,2*, Constance S. Shumba3,4, Lovemore Mapahla1 and Peter S. Nyasulu1,5 Abstract Background: Patient retention in care and sustained viral load suppression are a cornerstone to improved health and quality of life, among people living with HIV. However, challenges of retention on ART remain among female sex workers (FSWs). We report lost to follow up (LTFU), viral load suppression, and the associated factors among FSWs that access HIV treatment at primary health care facilities in Kampala. Methods: We retrospectively abstracted and analysed patient management data of HIV positive FSWs who enrolled in care between January 2018 to December 2020. LTFU was defined as failure of a FSW to return for treatment at least 90 days from the date of their last clinic appointment. We defined viral suppression as having a last viral load of ≤ 1000 copies/ml preceding data abstraction. Data were analysed using Stata 15.1 software. Results: A total of 275 FSWs were included in our study sample. We found low retention of 85.1% (n = 234) at six months, corresponding to LTFU of 14.9 (n = 41) within the same period. Retention decreased with duration of being in care up to 73.5% (n = 202) at 24 months, and this translates to LTFU of 26.5% (n = 73). Viral load testing coverage was 62% (n = 132) and of these, 90.9% (n = 120) were virally suppressed. Factors associated with LTFU in univariable logistic regression; and viral load suppression in multivariable logistic regression models were; having a telephone contact (OR: 0.3, 95% CI: 0.1–0.9 p = 0.031), having enrolled in HIV care aged ≥ 35 years (OR: 0.5, 95% CI: 0.2–1.0 p = 0.048), (OR:0.03, 95%CI: 0.00–0.5, p = 0.016); and having good ART adherence (OR: 0.2, 95% CI: 0.1–0.5 p = 0.001), (OR:24.0, 95% CI: 3.7–153.4 p = 0.001) respectively. Having good ART adherence remained statistically significant (OR: 0.2, 95% CI: 0.08–0.53 p = 0.001) in multivariable logistic regression for LTFU. Conclusion: This study found low retention among HIV diagnosed FSWs in care. Viral load suppression was acceptable and comparable to that of the general population, however viral load coverage was low. Strategies that increase *Correspondence: 1 Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Atuhaire et al. BMC Infectious Diseases (2022) 22:642 Page 2 of 12 retention in care and access to viral load testing such as individual client centred care models are vital to improve retention and viral load coverage among FSWs. Keywords: ART, Retention, Lost to Follow up, Viral Load Suppression, Female Sex Workers Introduction At the end of 2019, key populations including female sex workers (FSWs) and their sexual partners accounted for 65% of new HIV infections globally [1]. Eastern and Southern Africa regions were mostly affected and in 2020 alone, key populations and their sexual partners accounted for 32% of new infections and the HIV prevalence was 30.6% [1]. The new Global AIDS Strategy accentuate commitment to achieving 95, 95, 95 new HIV cascade targets of testing, treatment, and viral suppression with emphasis on high-risk sub populations such as FSWs [2]. These targets are only achievable by increasing the reach and strengthening access to HIV services, reinforcing prevention interventions, expanding treatment, and ensuring retention on treatment to achieve viral load suppression for all HIV positive populations especially the high-risk groups such as FSWs. The HIV epidemic in Uganda is generalised with an estimated HIV prevalence of 5.4% in 2020 among the population aged 15–49 [1]. Key Populations are most affected by the epidemic with FSWs having the highest HIV prevalence among all KP sub groups [1, 3]. According to Uganda AIDS Commission 2021 fact sheet, HIV prevalence is estimated at 31.3% among FSWs [4], a 4.6 times fold when compared to their female counterparts in the general population whose HIV prevalence is 6.8% [1]. Although Uganda has made substantial gains in HIV epidemic control and is one of the eight countries that achieved the 90-90-90, global HIV/AIDS 2020 targets [4], there are still population inequities in accessing HIV prevention and treatment services and FSWs are deeply affected. Indeed, the high prevalence among FSWs (31.3%), low ART coverage of 65% vs 96% among their female counterparts in the general population, low HIV status awareness of 88% vs 91% in the general population [1, 4] and sub-optimal condom use of 69.4% as well as active syphilis of 6.3% [1] in Uganda suggests that there are significant barriers for FSWs in obtaining access to a comprehensive package of essential health services. In Uganda sex work remains criminalised, leading to increased marginalisation and stigma [5]. Factors such as gender inequalities, physical violence, economic vulnerabilities, and discrimination hinder FSWs from accessing HIV prevention, treatment and affect FSWs’ retention in care thus suboptimal viral load suppression [6–8]. It is crucial to retain FSWs in HIV care and treatment programs to optimise viral suppression and improve health outcomes [9–11]. However, retention on ART and viral suppression among FSWs is a major challenge across different settings. A systematic review conducted among FSWs in Asia, Africa, North America, South America, and Central America and the Caribbean, reported a 38% current ART use among HIV infected FSWs with a 57% viral load suppressio (...truncated)