Retention in care, viral suppression and associated factors in HIV-positive key populations receiving antiretroviral therapy from Kampala Public Health Centers

Abstract

Introduction: HIV-positive Key populations (KPs) contribute about 50% of the global new HIV infection rates. We sought to compare the rates of virologic suppression, retention in care and factors associated with non-virologic suppression between KPs and general HIV-positive population (GPs) after six months of ART initiation between December 2014 and December 2016. Methods: This was a cross-sectional study conducted at seven public health centers within Kampala from January to March 2018. We reviewed clinical records of HIV-positive KPs (Men who have sex with men and Sex workers) and GPs. Virologic suppression and retention in care were expressed using frequencies (proportions). Factors associated with non-virologic suppression were analyzed using Logistic regression models with level of statistical significance at 0.05. Results: Of the 518 records reviewed, 235 (45%) were KPs. Compared to GPs, KPs had median age of 28 (IQR 25-31) vs. 32 (IQR 27–41) (p<0.01), female proportion 92.8% vs. 64.5% (p <0.01), median baseline CD4 cell count of 447 (IQR 302-672) vs. 313 (IQR 148-463) (p<0.01), and 95% treatment adherence at 71% vs. 92% (P<0.01) respectively. Virologic suppression in KPs vs. GPs was 86.1% vs. 88.6% (p=0.45) and proportion who remained active in care was 82.8% vs. 99% (p<0.01) respectively. KPs who delayed initiation of ART longer by a month were 9.62 times likely to achieve virologic suppression (95%C.I 1.92 – 48.21). Conclusion: KPs achieve comparable virologic suppression rates as GPs but are more likely to drop out of care. KPs need closer follow-up within the first six months of ART to improve retention outcomes.