\u2018Test and Treat\u2019 Among Women at High Risk for HIV-infection in Kampala, Uganda: Antiretroviral Therapy Initiation and Associated Factors

Yunia Mayanja,Pontiano Kaleebu,Janet Seeley,Gertrude Namale,Daniel Bagiire,Onesmus Kamacooko

doi:10.1007/s10461-017-1973-5

Yunia Mayanja, Pontiano Kaleebu + Show 4 more

Open Access

https://doi.org/10.1007/s10461-017-1973-5

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Abstract

Data on implementation of ‘Test and Treat’ among key populations in sub-Saharan Africa are still limited. We examined factors associated with prompt antiretroviral therapy/ART (within 1 month of HIV-positive diagnosis or 1 week if pregnant) among 343 women at high risk for HIV infection in Kampala-Uganda, of whom 28% initiated prompt ART. Most (95%) reported paid sex within 3 months prior to enrolment. Multivariable logistic regression was used to determine baseline characteristics associated with prompt ART. Sex work as main job, younger age and being widowed/separated were associated with lower odds of prompt ART; being enrolled after 12 months of implementing the intervention was associated with higher odds of prompt ART. Younger women, widowed/separated and those reporting sex work as their main job need targeted interventions to start ART promptly after testing. Staff supervision and mentoring may need strengthening during the first year of implementing ‘test and treat’ interventions.

Highlights

Throughout the world, key populations who include: sex workers, injecting drug users (IDU), men who have sex with men (MSM), transgender people and fisher-folk are disproportionately burdened by the HIV epidemic [1,2,3,4,5]
Women joined thetest and treat cohort’ during the study period, because 44 participants who were HIV-negative became HIV-positive during the study period
We found that a low proportion of women initiated prompt ART compared to other studies that have examined the delivery of the test and treat intervention [19,20,21]

Summary

Introduction

Throughout the world, key populations who include: sex workers, injecting drug users (IDU), men who have sex with men (MSM), transgender people and fisher-folk are disproportionately burdened by the HIV epidemic [1,2,3,4,5]. These key populations and their sexual partners account for 10–51% of new infections in sub-Saharan Africa (SSA) [6,7,8]. Following the START trial results [15], and the release of the WHO ‘Guidelines on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV’ [16], the global HIV response is aimed at reducing HIV transmission by giving prompt ART to all HIV-positive people, a challenging and ambitious goal

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