Abstract:
Background: Key populations (KPs) account for quarter of all new HIV infections in sub-Saharan Africa. In Tanzania, 14.9% of HIV infected adults in the general population are not virally suppressed. Given the high burden of HIV among KPs, it is imperative to understand the extent of virological non-suppression among these marginalized groups.
Aim: To determine the prevalence and predictors of virological non-suppression among female sex workers (FSW), people who inject drugs (PWIDs), and men who have sex with other men (MSM) on first line antiretroviral therapy (ART) in Zanzibar.
Methods: This was a retrospective cross sectional study that involved review of medical records of HIV infected FSW, PWID and MSM who were initiated ART between January 2016 to December 2018. All key populations who had viral load results after six months of using ART were included in the study. Prevalence of virological non-suppression was calculated from proportion of KPs with plasma RNA levels above 1000 copies/ml among all KPs with viral load results after six month of ART. Proportion of treatment failure was a number of participants who remained unsuppressed out of all who received enhanced adherence counseling (EAC). Logistic regression was used to identify factors that predicted virological non-suppression among key populations. A two sided p-value <0.05 were considered statistical significant.
Results: Of the 174 key populations enrolled into the study, 29/174 (16.7%) were virological unsuppressed after six month of ART. Virological non-response was highest among MSM 26.1%, followed by PWID 22.2% and FSW 12.3%. Nearly half (44.5%) of all unsuppressed KPs progressed to virological treatment failure. In adjusted analyses; poor medication adherence and non-disclosure of HIV status were independently associated with virological non-suppression in all groups. The odds for virological non–suppression among FSW, PWIDs and MSM with poor adherence were; OR=5.5 (95%CI: 2.1-14.6), OR=4.8 (95% CI: 1.7-13.3) and OR=5.1 (95% CI: 1.4-18.6) respectively. Similarly, the odds of virological non-response among FSW, PWIDs and MSM with non-disclosure status were; OR=4.5 (95% CI: 0.7-27.4), OR=1.7 (95% CI: 0.7-17.4), and OR=1.8 (95% CI: 0.5-11.3) respectively. TB co-infection increased the odds of virological non-suppression among PWIDs, OR=4.4, (95% CI: 0.9-22.0).
Conclusion: Viral non-suppression rates among key population in Zanzibar are higher above UNAIDS targets. Poor adherence and non-disclosure of a positive HIV status are significant predictors of virological non-suppression among key populations.
