Trends and factors associated with HIV viral load non-suppression among treatment-experienced female sex workers in Kenya: a retrospective cohort study.

Background: Transactional sexual relations in the absence of condom use is a well-established behaviour that strongly contributes to HIV transmission if the infected person is not virally suppressed. In this study, we determined the trends and factors associated with VLNS among treatment-experienced FSWs in Kenya.

Methods: This retrospective cohort study used data collected from 7-sex workers outreach clinics between 2015 and 2022. VLNS trends were determined using the Modified Mann-Kendall test, and the effects of covariates on VLNS odds were examined using generalized estimating equations (GEE) with a logit link.

Results: 12,117 viral load tests were performed on samples collected from 1,947 FSWs. The prevalence of VLNS decreased from 25.5% (95%CI 17.6-34.6) in 2016 to 4.3% (95%CI 2.5-6.7) in 2021. The odds of VLNS decreased by 9% per year during the study period in the multivariable GEE analysis adjusted for covariates (regimen, age, and sex worker outreach program (SWOP) clinic), (OR 0.91, 95%CI 0.84-0.98; P = 0.005). Age was a significant factor associated with VLNS, with younger women (18-24 years) having 2.2 times higher odds of VLNS (OR 2.15 95%CI 1.10-4.20; P = 0.025) than those aged >55 years (reference). Subjects on dolutegravir (DTG)-based cART regimen had 64% lower odds of VLNS (OR 0.36, 95%CI 0.25-0.52; P < 0.001) compared to those on PI-based regimen.

Conclusions: There is a strong evidence of decreasing population level viremia among FSWs during the study period. To maintain the trend, it is necessary to continue supporting SWOP clinics in order to provide HIV treatment services to this key population.