# Adherence to antiretroviral therapy among female sex workers in Kampala, Uganda

## TL;DR

This study examines how well female sex workers in Kampala, Uganda, follow their HIV treatment and finds that owning a phone and being older are linked to better adherence.

## Contribution

The study identifies factors influencing ART adherence among female sex workers and suggests mobile phone-based interventions as a novel approach.

## Key findings

- 59.2% of participants were adherent to ART, with being away from home and forgetfulness as major barriers.
- Owning a phone and being older were associated with higher adherence, while being a widow was linked to lower adherence.
- The study supports integrating mobile phone-based strategies into HIV care for this population.

## Abstract

Increased access to antiretroviral therapy (ART) for key populations who bear a disproportionate burden of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), including female sex workers (FSWs), reduces onwards transmission. This is, however, dependent on achieving high levels of adherence to ART.

To determine the level of adherence to ART and associated factors among FSWs.

An urban HIV clinic in Kampala, Uganda.

This cross-sectional study enrolled 226 FSWs accessing HIV care between May 2017 and June 2017. We assessed self-reported adherence using interviewer-administered questionnaires and reviewing medical records. We defined high-level adherence as those who scored ≥ 95% at assessment. Using multivariable logistic regression, we identified factors independently associated with adherence.

Overall, 59.2% of participants were adherent to ART. Major reasons for non-adherence were being away from home (40.8%) and forgetfulness (26.7%). In the multivariable model, owning a phone (adjusted odds ratios [AOR]: 2.90; 95% confidence intervals [CI]: 1.07, 7.88), a 10-year increase in age (AOR: 1.60; 95% CI: 1.00, 2.60) and being a widow (AOR: 0.22; 95% CI: 0.05, 0.87) were independently associated with adherence.

This baseline assessment builds a case for the development and scale-up of targeted intervention strategies to increase ART adherence among FSWs. Incorporating information and communication technology in routine adherence counselling could be scaled up among FSWs.

Our study highlights the possibility of integrating mobile phone-based adherence support in routine HIV care and informs the design of targeted interventions to curtail HIV transmission.