Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda

Abstract

Background: We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV.

Methods: Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates.

Results: The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%).

Conclusions: HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts.

Fig 1. FSW serosurvey results compared with population-level UNAIDS 90-90-90 targets, Crane Survey, Kampala, Uganda, 2012.

¹Serostatus knowledge (yellow) includes all HIV positive women who self-reported a previous positive test result; blue column also includes FSW with viral suppression. ²On ART (yellow) includes all HIV positive women who self-reported taking ARTs; blue column also includes FSW with viral suppression. ³Viral suppression was laboratory-based and defined as <1000 copies/ml. ⁴Denominator for viral suppression was n = 341 due to missing data; the denominator for all other characteristics was n = 485. ⁵Error bars represent 95% confidence intervals.

Fig 2. FSW serosurvey results compared with population-level UNAIDS 90-90-90 targets by selected viral load suppression thresholds, Crane Survey, Kampala, Uganda, 2012.

¹Serostatus knowledge (yellow) includes all HIV positive women who self-reported a previous positive test result; blue column also includes FSW with viral suppression. ²On ART (yellow) includes all HIV positive women who self-reported taking ARTs; blue, green, purple columns also includes FSW with viral suppression by definition. ³Denominator for viral suppression was n = 341 due to missing data; the denominator for all other characteristics was n = 485. ⁴Error bars represent 95% confidence intervals.