Determinants Of Sustained Virological Suppression In HIV-1 Infected Female Sex Workers In The Sex Worker Outreach Project (Swop), Nairobi County

Abstract

The goal of anti-retroviral therapy is to stem the replication of HIV virus to a point below which drug fighting mutation do not emerge, restore and preserve immune function, reduce AIDS-related events and improve the life span of the patient. By the end of 2016, there were 1.5 million PLWH in Kenya, with 59% on ART. Nairobi carries the highest population of sex workers, a key population in HIV transmission. The rate of viral suppression among PLWH on ART (74%) in Nairobi County stands at 41%. For a County with approximately 39,494 sex workers whose HIV prevalence is high (29.3% among female sex workers and 18.2% among male who have sex with men) relative to the County prevalence, there’s need to improve the rate of viral suppression. The objective of the study was to determine factors influencing sustained viral load suppression in female sex workers initiated into care at the sex worker outreach project in Nairobi. This was a retrospective cohort study using secondary data collected from HIV positive female sex workers initiated into care at SWOP City clinic between 1st January, 2014 and 1st January, 2015. The outcome of interest was the virological status of the patient after two years from the time of initiation into care. The study findings indicated that having history of tuberculosis infection (OR=2.40, P<0.001) and not consistently using condoms use when having sex with clients/partners (OR=2.11, P=0.002) significantly increases the risk of virological failure among female sex workers who had previously achieved complete viral suppression. Special attention should be accorded to HIV positive sex workers with history of tuberculosis and appropriate changes in course of treatment done should they present symptoms of emerging drug resistance to sustain suppressed viral replication. There’s also need for continuous training on how to negotiate for condom use among HIV positive sex workers receiving HIV treatment.