Theme: Epidemiology & Public Health Research Year: 2024
Background: South Africa has the largest HIV epidemic globally. People who inject drugs (PWID) are a key population with a high prevalence of HIV, ranging from an estimated 30,3% in Mbombela (Ehlanzeni) to 49,6% in eThekwini and 71,9% in Tshwane. These are coupled with poor retention in care for those initiated on anti-retroviral therapy (ART). Optimal adherence to ART is critical to viral suppression and achieving the 95-95-95 goals. This study examined factors associated with retention in care among PWID who were initiated on ART between July 2022 and March 2023 in the three South African municipality districts.
Methods: A retrospective cohort study was conducted with N=333 PWID who were on ART. The target population were PWID, aged 18 years and older who were initiated on ART between July 2022 and March 2023. Routine patient-level HIV information was extracted from the Tier.net electronic database. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 28. Kaplan Meier estimates were used to describe retention in care at 6 months and the cox proportional hazard model was used to determine factors associated with retention in care.
Results: From the N=333 PWID on ART in this study, 40% (n=132) were retained in care. The multivariate logistic regression analysis showed that housing and enrollment on opioid agonist therapy (OAT) were determinants of retention in care. The odds of being retained in care reduced with homelessness/unstable housing (AOR = 4.94; CI: 2.35-10.35). Those on OAT were 74.4% more likely to be retained in care (AOR = 0.25; CI: 0.10-0.60). In a bivariate analysis, having a treatment supporter while on OAT was strongly associated with retention in care (p<0.001*).
Conclusion:
Retention in care among PWID on ART in the three South African districts is still below the 95% target. Strengthening of harm reduction strategies for PWID is critical to improve retention in HIV care.