Women engaged in commercial sex living with Human Immunodeficiency Virus and viral non-suppression in Uganda: analysis of multiple respondent-driven sampling surveys, 2021—2023

BACKGROUND: Human Immunodeficiency Virus (HIV) Viral load non-suppression (VNS) among women engaged in commercial sex (WECS) is unknown even with persistent new HIV infections in the general population. The objective of this study was to find out the factors correlated with VNS among WECS living with HIV (WECS-LHIV) in Uganda. METHODS: Cross-sectional data were collected through respondent driven sampling (RDS) in Kampala Capital City and 11 upcountry towns. All consented WECS-LHIV reporting commercial sex 3 months prior to the surveys were tested for HIV and viral load (VL), active syphilis and high-risk human papilloma virus (hr.HPV) which was based on genotypes 16 and 18 that are highly associated with all cervical cancer cases. VNS was defined as any VL measure < 1,000 copies/ml. Analysis of correlates of VNS were restricted to WECS-LHIV with VL results irrespective of their antiretroviral therapy (ART) status. We examined variables including - age, marital status, education, active syphilis, hr.HPV and reported ART use to identify correlates of VNS. Sampling weights to reflect the complex sampling design were applied. RESULTS: Of 2,674 WECS-LHIV (median age 32 years, interquartile range (IQR) 27-37), 667 (24.9%) had VNS. The findings show that 19.2% and 29.7% of WECS-LHIV with VNS had active syphilis and hr.HPV co-infections respectively. WECS-LHIV had reduced odds of VNS if they were aged 30-49 years ([adjusted odds ratio (aOR): 0.46, 95% confidence interval (CI): 0.30-0.69, p < 0.001)] vs. 18-24 years and if they self-reported ART use [aOR: 0.38, 95% CI: 0.28-0.52, p = < 0.001 vs. non-self-reporting ART]. CONCLUSIONS: Young women engaged in commercial sex(YWECS) and none ART disclosure WECS may increase risk of new HIV infections in general population. Increase on frequency of ART adherence and viral load monitoring of YWECS including continuous surveillance of the second and third 95 HIV continuum of care and treatment for hidden populations may aid in reduction of new HIV infections burden in Uganda and other low- and middle-income countries.