Brief Report: Antiretroviral Treatment Use Over Time Among Adolescents and Young Adults in the Rakai Community Cohort Study, 2011-2020.

Background: In sub-Saharan Africa, pediatric and adult treatment programs have not met the needs of youth living with HIV (15-24 years), whose enrollment in antiretroviral treatment (ART) programs is much lower than that of adults. To inform targeted interventions, we analyzed factors associated with ART use among youth in Uganda.

Methods: Data were from 42 communities between 2011 and 2020 (5 survey rounds) from the Rakai Community Cohort Study, an open, population-based cohort. Among youth, we assessed trends in ART use over time and demographic characteristics and sexual behaviors associated with ART use.

Results: Youth (N = 1518) contributed 2101 person-visits. ART coverage increased over time with 8% of men and 11% of women on ART in 2011-2013 and 45% and 68%, respectively, on ART in 2018-2020 (AORwomen vs. men=2.57; 95% CI: 1.72 to 3.84). Youth with 2 or more sexual partners compared with youth with 0-1 sexual partner were less likely to be on ART (men AOR = 0.40; 0.19-0.82; women AOR = 0.54; 0.41-0.72). Youth who reported consistent condom use were more likely to be on ART (men AOR = 2.94; 95% CI: 1.14 to 7.57; women AOR = 1.70; 95% CI: 1.00 to 2.88).

Conclusions: In this longitudinal study, ART use among youth increased over time, yet at 63% remained well below UNAIDS 95-95-95 goals, thus depriving many of lifesaving treatment. Those engaging in fewer protective sexual behaviors had lower ART use, thus further increasing risk of future HIV transmission. Targeted efforts are needed to ensure rapid initiation of ART and continued engagement among this vulnerable population.