Factors Influencing Virological Suppression Among Hiv Infected Sex Workers and General Populations in Homa Bay County, Kenya

Abstract

By 2019, 36.9 million people were living with the HIV globally with about 67.8% on antiretroviral therapy (ART). In Kenya, 54% of 1.6 million people living with HIV (PLHIV) know their status, 73% of whom are on ART and of these 68% are virally suppressed. Homa Bay County has a HIV prevalence of 20.7% with 79% PLHIV taking ART out of whom 79% are virally suppressed. Viral suppression is critical to curbing HIV transmission and preventing drug resistance. Among key populations, viral suppression varies widely from 20% among men who have sex with men (MSM) to 70% among female sex workers (FSW). Recent reports from Homa Bay County indicate viral suppression rate of 80% in the general population (GP) compared to 98% for FSW and 99% for MSM. However, factors that mediate differences in viral suppression between the general and key populations are unknown. The current study investigated factors underlying its occurrence, particularly in integrated public health facilities providing differentiated HIV care. Specifically, the study determined the association between risky behavior, socio-demographic and clinical characteristics and viral load. Through a cross sectional design, qualitative and quantitative data was collected from a targeted population of 663(376 GP and 287 KP) HIV infected FSW and GP enrolled for ART services in three integrated health facilities providing differentiated HIV care. Participant mean age was 38.4 years (SD= 6.9) and 35.4 years (SD 7.6) for KP and GP respectively. Viral suppression among KPs was 94.5% (n=271) versus GPs, 89.4% (n=338) (p=0.027). Anti-retroviral regime (KP 95.5%, X2 = 42.365; P<0.0001; GP 89.9%, X2 = 11.1667; P=0.025) and ART adherence (KP X2 = 106.4599; P<0.0001; GP X2 = 33.8846; P<0.0001) were significantly associated with VL suppression in both populations. In contrast, TB/Pneumonia (X2 = 8.6742; P=0.003), duration on ART (X2 = 33.400; P<0.004) and regime switch (X2 = 26.2631; P<0.001) incidence predicted poor viral load suppression among KP with disproportionately higher ORs for poor adherence (OR 65.5332, 95% CI 7.850-547.079, p< 0.0001). Particularly, use of alcohol and substance abuse (X2 =20.6090; p<0.0001) and gender-based violence, (X2 = 4.7586; p=0.029) were associated with poor VL suppression among GP. Overally, a high prevalence of STI of 34.8% was observed. Results indicate that viral suppression is a function of personal, interpersonal and systems factors. KPs are comparatively more vulnerable to poorer VL controls. Differentiated care is therefore recommended so as to improved population differences in the health outcomes among PLHIV.