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Abstractobjective To evaluate HIV drug resistance (HIVDR) and determinants of virological failure in a large cohort of patients receiving first-line tenofovir-based antiretroviral therapy (ART) regimens.methods A nationwide retrospective cohort from 42 health facilities was assessed for virological failure and development of HIVDR mutations. Data were collected at ART initiation and at 12 months of ART on patients with available HIV-1 viral load (VL) and ART adherence measurements. HIV resistance genotyping was performed on patients with VL ≥1000 copies/ml. Multiple logistic regression was used to determine factors associated with treatment failure.results Of 828 patients, 66% were women, and the median age was 37 years. Of the 597 patients from whom blood samples were collected, 86.9% were virologically suppressed, while 11.9% were not. Virological failure was strongly associated with age <25 years (adjusted odds ratio [aOR]: 6.4; 95% confidence interval [CI]: 3.2-12.9), low adherence (aOR: 2.87; 95% CI: 1.5-5.0) and baseline CD4 counts <200 cells/ll (aOR 3.4; 95% CI: 1.9-6.2). Overall, 9.1% of all patients on ART had drug resistance mutations after 1 year of ART; 27% of the patients who failed treatment had no evidence of HIVDR mutations. HIVDR mutations were not observed in patients on the recommended second-line ART regimen in Rwanda.conclusions The last step of the UNAIDS 90-90-90 target appears within grasp, with some viral failures still due to non-adherence. Nonetheless, youth and late initiators are at higher risk of virological failure. Youth-focused programmes could help prevent further drug HIVDR development.

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Establishing accurate population size estimates (PSE) is important for prioritizing and planning provision of services. Multiple source capture-recapture sampling method increases PSE accuracy and reliability. In August 2018, the three-source capture-recapture (3S-CRC) method was employed with a stringent assumption of sample independence to estimate the number of female sex workers (FSW) in Rwanda. Using Rwanda 2017 FSW hotspots mapping data, street and venue based FSW were sampled at the sector level of each province and tagged with two unique gifts. Each capture was completed within one week to minimize FSW migration between provinces and recall bias. The three captures had 1042, 1204 and 1488 FSW. There were 111 FSW recaptured between captures 1 and 2; 237 between captures 2 and 3; 203 between captures 1 and 3, and 46 captured in all three. The PSE for street and venue based FSW in Rwanda lies within 95% credible set: 8,328-22,806 with corresponding median of 13,716 FSW. The 3S-CRC technique was low-cost and relatively easy to use for PSE in hard-to-reach populations. This estimate provides the basis for determining the denominators to assess HIV program performance towards FSW and epidemic control and warrants further PSE for home-and cyber-based FSW in Rwanda.