Background Patient retention in care and sustained viral load suppression are a cornerstone to improved health and quality of life, among people living with HIV. However, challenges of retention on ART remain among female sex workers (FSWs). We report lost to follow up (LTFU), viral load suppression, and the associated factors among FSWs that access HIV treatment at primary health care facilities in Kampala. Methods We retrospectively abstracted and analysed patient management data of HIV positive FSWs who enrolled in care between January 2018 to December 2020. LTFU was defined as failure of a FSW to return for treatment at least 90 days from the date of their last clinic appointment. We defined viral suppression as having a last viral load of ≤ 1000 copies/ml preceding data abstraction. Data were analysed using Stata 15.1 software. Results A total of 275 FSWs were included in our study sample. We found low retention of 85.1% (n = 234) at six months, corresponding to LTFU of 14.9 (n = 41) within the same period. Retention decreased with duration of being in care up to 73.5% (n = 202) at 24 months, and this translates to LTFU of 26.5% (n = 73). Viral load testing coverage was 62% (n = 132) and of these, 90.9% (n = 120) were virally suppressed. Factors associated with LTFU in univariable logistic regression; and viral load suppression in multivariable logistic regression models were; having a telephone contact (OR: 0.3, 95% CI: 0.1–0.9 p = 0.031), having enrolled in HIV care aged ≥ 35 years (OR: 0.5, 95% CI: 0.2–1.0 p = 0.048), (OR:0.03, 95%CI: 0.00–0.5, p = 0.016); and having good ART adherence (OR: 0.2, 95% CI: 0.1–0.5 p = 0.001), (OR:24.0, 95% CI: 3.7–153.4 p = 0.001) respectively. Having good ART adherence remained statistically significant (OR: 0.2, 95% CI: 0.08–0.53 p = 0.001) in multivariable logistic regression for LTFU. Conclusion This study found low retention among HIV diagnosed FSWs in care. Viral load suppression was acceptable and comparable to that of the general population, however viral load coverage was low. Strategies that increase retention in care and access to viral load testing such as individual client centred care models are vital to improve retention and viral load coverage among FSWs.

Background Patient retention in care and sustained viral suppression are a cornerstone to improved health and quality of life, among people living with HIV. However, challenges of retention on ART remain among female sex workers (FSWs). We report lost to follow up (LTFU), viral load suppression, and the associated factors among FSWs that access HIV treatment at primary health care facilities in Kampala. Methods We retrospectively abstracted and analysed patient management data of HIV positive FSWs who enrolled in care between January 2018 to December 2020. LTFU was defined as failure of a FSW to return for treatment at least 90 days from the date of their last clinic appointment. We defined viral suppression as having a last viral load of ≤ 1000 copies/ml preceding data abstraction. Data were analysed using Stata 15.1 software. Results A total of 275 FSWs were included in our study sample. We found LTFU of 26% (n = 73) at 24 months, retention was 85% (n = 234) at six months and it decreased with duration of being in care to 74% (n = 202) at 24 months. Viral load testing coverage was 56% (n = 135) and of these, 89.6% (n = 121) were virally suppressed. Factors associated with LTFU in univariable logistic regression; and viral suppression in multivariable logistic regression models were; having a telephone contact (OR: 0.3, 95% CI: 0.1–0.9 p = 0.031), (OR:14.1, 95%CI: 1.10-182.05 P = 0.042); having enrolled in HIV care aged > 35 years (OR: 0.5, 95% CI: 0.2-1.0 p = 0.048), (OR:0.10, 95%CI: 0.00-0.75, p = 0.029); and having good ART adherence (OR: 0.2, 95% CI: 0.1–0.5 p = 0.001), (OR:14.8, 95%CI: 2.64–83.08 p = 0.002) respectively. Having good ART adherence remained statistically significant (OR: 0.22, 95% CI: 0.08–0.53 p = 0.001) in multivariable logistic regression for LTFU. Conclusion This study found low retention among HIV diagnosed FSWs in care. Viral load suppression was acceptable and comparable to that of the general population, however viral load coverage was low. Strategies that increase retention in care and access to viral load testing such as individual client centred care models will go a long way to improve retention and viral load coverage among FSWs.

Background Frequent HIV testing at intervals of every three to six months is recommended among HIV negative female sex workers as the first entry point to HIV prevention and treatment. In this study, we examined the extent to which HIV negative female sex workers adhere to the testing guidelines by measuring the frequency of testing in the last 12 months and identified associated factors among female sex workers in Kampala Uganda. Methods We conducted a cross-sectional study using structured questionnaires. Using equal probability selection method, 12 hotspots were selected, and 200 participants interviewed based on   proportional allocation in each hotspot. We used descriptive statistics to describe female sex workers' characteristics, and multivariable logistic regression model to determine the factors associated with their adherence to the HIV testing guidelines. Adherence to the HIV testing guidelines was defined as having tested three or more times in the last 12 months. Factors with p-value ≤0.05 significance level were considered statistically significant. Results From the 200 study participants, 43% were aged 25-30 years, joined sex work between the ages of 18 to 24 years, 49% had attained primary and 41% secondary school respectively. 88% reported HIV testing status, of which 56% had tested three or more times in the 12 months preceding the survey. Attaining secondary education, was independently associated with adherence to the HIV testing guidelines (OR 1.86, 95% CI: 1.01 - 3.44, p=0.047). Those that had tested for STIs in the last three months (OR= 2.13, 95% CI: 0.95 - 4.74, p=0.065) and accessed HIV testing in a drop-in centre (OR= 5.90, 95% CI: 0.71 - 49.1, p=0.101) had higher odds of adhering to the HIV testing guidelines Conclusion This study found suboptimal adherence to the HIV testing guidelines among HIV negative female sex workers. Interventions such as HIV self-testing that improve access to, and frequency of HIV testing need to be taken to scale. There is need for rigorous behaviour change program evaluation to continually refine understanding of the message mix, to ensure simplified and easy to comprehend awareness messages are designed for female sex workers with no formal education.

Objectives To describe the impact of the COVID-19 pandemic on the TB care cascade. Methods In this systematic review, the Cochrane library, Scopus, CINAHL, Ebscohost, and PubMed databases were comprehensively searched from the onset of the pandemic, till May 5th, 2022. Eligible studies were those reporting on changes in the TB cascade of care one year before and one year during the COVID-19 pandemic. Due to the expected differences in the contexts of the included studies, a narrative synthesis was conducted. Results Twenty-seven studies, from Asia, North America, Africa, South America, and Europe were included. TB screening decreased by between 1% - 50%, and multidrug resistance tuberculosis (MDR-TB) screening decreased by between 15%-17%. Diagnostic delay increased by between 35 - 45 days, contact tracing decreased by up to 36.1%, and case notification decreased by between 3%-63%. TB treatment enrolment decreased by between 16%-35.0%, treatment completion decreased by around 8.0% and treatment success decreased by up to 17.0%. Conclusion COVID-19 had a detrimental impact on the TB care cascade and these findings suggest a need for policies to protect healthcare systems for TB and other communicable diseases in future health emergencies.

Objectives To compare mortality, hospitalization, and the need for intensive care services due to COVID-19 between PLHIV and individuals without HIV based on data from the existing literature. Methods A comprehensive search in PubMed, Cochrane Library, Scopus, China Academic Journals Full Text Database, the Database of Abstracts of Reviews of Effectiveness (DARE) and and the medRXIV and bioRxiv databases of preprints was carried out. Each data source was searched from 1 January 2020 to 20th of February 2021. Eligible studies were case control, cross-sectional and cohort studies where participants had confirmed COVID-19. From each study, data on numbers of PLHIV and individuals without HIV for each outcome were extracted. Study quality was assessed using the MethodologicAl STandard for Epidemiological Research (MASTER) scale. Data synthesis used a bias adjusted model and predefined age and geographical subgroups were analysed. Results Of a total of 2757 records identified, 11 studies, from 4 countries, the United Kingdom, Spain, the United States of America and South Africa, were included. The total participants assessed for the outcomes in this meta-analysis were 1268676 of which 13886 were PLHIV. Overall, the estimated effect of HIV on mortality suggested some worsening (OR 1.3, 95% CI: 0.9 to 2.0, I2 = 78.6%) with very weak evidence against the model hypothesis at this sample size. However, in individuals aged less than 60 years, the estimated effect on mortality suggested more worsening in PLHIV (OR 2.7, 95% CI: 1.1 to 6.5, I2 = 95.7%) with strong evidence against the model hypothesis at this sample size. HIV was also associated with an estimated effect on hospitalization for COVID-19 that suggested worsening (OR 1.6, 95% CI: 1.3 to 2.1, I2 = 96.0%) also with strong evidence against the model hypothesis at this sample size. A secondary analysis of the included studies suggested no difference, by HIV status, in the prevalence of pre-existing conditions. Conclusion People living with HIV have higher risk of death and hospitalisation from COVID-19, compared to individuals without HIV. A secondary analysis suggests this is not due to associated comorbid conditions. The difference in mortality is exaggerated in those younger than 60 years of age.