Uptake of antiretrovirals in a cohort of women involved in high risk sexual behaviour

in Kampala, Uganda

J.Bukenya , M. Kwikiriza, O. Musana, J. Ssensamba , J. Bwana , H. Grosskurth, J. Vandepitte

UVRI/MOH UGANDA

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Background• Access to ART has been increasing in Uganda

– 39 % in 2006– 53.5% in 2009

• Female sex workers identified high risk group– HIV prevalence 37.2% vs 6.4% national average

• Limited data on access to ART in female sex workers– For their own health– Prevention of transmission benefit

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KAMPALA

Lake Victoria

Good Health for Women Project KampalaMRC/UVRI Uganda Research Unit on AIDS

GHWPCohort of 1027 women who report involvement in sex workenrolled Apr 08 – May 09

Aim– study epidemiology of HIV & STIs – conduct HIV prevention interventions

Women attend clinic 3 monthly– social demographic data– data on sexual behaviour– blood & genital samples

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GHWP clinic servicesGeneral medical care

– participants & children <5 yrs

HIV Counselling & Testing

Health education

Free condoms

Contraception

Screening & treatment STIs

Antenatal care

Referral for ART5

HIV Status - findings at screening

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%

Only one woman did not consent to having an HIV test

Objective

To describe access to and uptake of ART among eligible HIV positive women who engage in high risk sexual behaviour in Kampala, Uganda

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CD4-counts

CD4 ≤ 250/ μl CD4 > 250 /μl

Liver and renal function tests Full blood countsPre-ART counsellingAccompanied Referral for ART initiation

Reassess:

251- 400: 3 monthly

> 400: 6 monthly

All women receive CTX prophylaxis and ongoing counselling

Management of HIV-positive study participants

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Clients eligible for ART

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HIV-positives at enrolment n= 382

(Prevalence: 37.2%)

HIV-sero converters during follow-up (April 08 – June10)

n= 34 (Incidence: 5.0 / 100 py)

Returned for CD4-counts 411 / 416 (98.8%) *

CD4 ≤ 250/μl n=177

CD4 > 250/μl n=234

* 2 women waiting for CD4-testing, 3 women did not return for CD4 assessment

Uptake of ART

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Not on ART yet n= 142 (80%)

Already on ART at enrolment n= 35 (20%)

Eligible for n=177

Referred to ART providing centre n= 130 (92%) *

Started ART n= 89 (69%)

Missing at ART centre

n= 23 (17%)

* 8 women awaiting referral, 1 died and 3 missing for > 2 months

On ART pathway n= 13 (10%)

Died n= 5 (4%)

Discussion

• High acceptability of HCT services

• High HIV prevalence (37.2%)

• High HIV incidence (5.0%)

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Discussion

• Low uptake of ART before enrolment– Only 20% of eligible women had accessed ART

• GHWP Project : increased uptake– Pre-assessment for ART– Baseline monitoring test– Pre-ART counselling– Continuing medical care in a trusted environment– Accompanied referral to ART provision centres– Regular follow up and defaulter tracing

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Barriers to ART uptake

Access to ART centres

Stigma, fear, denial

Alcohol & substance use

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Lack of family support [drug companion / disclosure]

Recommendations

Vulnerable high risk populations such as female sexworkers require tailored interventions for sustained access to HIV testing and treatment

Further research is needed to understand and overcome barriers to effective control and treatment of HIV infection in this population

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Acknowledgements• Good Health for Women Project Kampala staff and

study participants

• Women at Work International (WAWI)

• Collaborating ART providing centres in Kampala,in particular Nsambya Hospital

• Medical Research Council, UK

• EDCTP

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