Background:
In sub-Saharan Africa, the region with the largest global HIV epidemic, pediatric and adult treatment programs have not met the needs of adolescents and young adults living with HIV (AYALWHIV: 15–24 years), whose enrollment in antiretroviral treatment (ART) is much lower than adult enrollment in ART. To inform targeted interventions, the current study analyzed factors associated with ART use among AYALWHIV in Uganda.
Methods:
Data were collected from 42 communities between 2011 and 2020 (5 survey rounds) from the Rakai Community Cohort Study, an open, population-based cohort. Among AYALWHIV, we assessed trends in ART use over time and demographic and sexual behavior factors associated with ART use.
Results:
AYALWHIV (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% of men and 68% of women on ART in 2018-2020 (AORwomen vs. men=2.57; 95%CI 1.72, 3.84). People with two or more sexual partners compared to 0-1 partners were less likely to be on ART (Men AOR=0.40; 0.19, 0.82; Women AOR=0.54; 0.41, 0.72). People who reported consistent condom use were more likely to be on ART (Men AOR=2.94; 95% CI 1.14, 7.57; Women AOR=1.70; 95% CI 1.00, 2.88).
Conclusion:
In this longitudinal study, ART use among AYALWHIV increased over time, yet remained well below UNAIDS 95-95-95 goals. Engaging in less protective sexual behavior was associated with lower ART use. Targeted efforts are needed to ensure rapid initiation of ART and continued engagement among AYALWHIV.