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Self-Reported Adherence to Antiretroviral Therapy (ART) Among Women Engaged in Commercial Sex Work in Southern Uganda

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Abstract

We examined the correlates of self-reported adherence to antiretroviral therapy (ART) among women engaged in commercial sex work (WESW) in Uganda. We used baseline data from a longitudinal study, which recruited 542 WESW in Southern Uganda. We used nested regression models to determine the individual and family, and economic level correlates of self-reported adherence. Study findings show that older age (OR = 1.07, 95% CI = 1.013, 1.139), secondary education (OR = 2.01, 95% CI = 1.306, 3.084), large household size (OR = 1.08, 95% CI = 1.020, 1.136), high family cohesion (OR = 1.06, 95% CI = 1.052, 1.065), and high financial self-efficacy (OR = 1.07, 95% CI = 1.006, 1.130) were associated with good self-reported adherence to ART. Married women (OR=-0.39, 95% CI = 0.197, 0.774), depression (OR = 0.85, 95% CI = 0.744, 0.969), alcohol use (OR = 0.72, 95% CI = 0.548, 0.954), ever been arrested (OR = 0.58, 95% CI = 0.341, 0.997), and high household assets ownership (OR = 0.48, 95% CI = 0.313, 0.724) were associated with poor self-reported adherence to ART. Findings suggest a need to adopt a multi-level approach to address gaps in ART adherence among WESW.

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Data Availability

Due to the sensitivity around the data, the data will not be deposited in a data repository. However, data used in this analysis is available upon reasonable request. The team is open to data sharing provided the points outlined below, which were part of the study protocol, data sharing plan, and consenting process, are met; (1) A formal research question is specified a priori; (2) Names, affiliations, and roles of any other individuals who will access the shared data; 3) The deliverable(s)—e.g., manuscript, conference presentation—are specified a priori; 4)Proper credit and attribution—e.g., authorship, co-authorship, and order—for each deliverable are specified a priori; 5) A statement indicating an understanding that the data cannot be further shared with any additional individual(s) or parties without the PI’s permission; 6) IRB approval for the use of the data (or documentation that IRB has determined the research is exempt).

Code Availability

Statistical analysis code is available at the request of the first author.

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Acknowledgements

We are grateful to WESW in Southern Uganda, who agreed to participate in the study; this work could not be possible without them. Special thanks to the International Centre for Child Health and Development (ICHAD) at the Masaka Field Office, who coordinated the study in Uganda with study partners, Rakai Health Sciences Program and Reach the Youth Uganda. Lastly, to the research teams at Washington University in St. Louis, Columbia University in New York, University of North Carolina, Chapel Hill, and New York University. Kyaterekera study is funded by the National Institute of Mental Health (NIMH) under award number R01MH116768 (MPIs: Fred M. Ssewamala, PhD & Susan Witte, PhD). NIMH was not involved in the study design, data collection, analysis, findings interpretation and manuscript preparation. The content in this article does not reflect the views of NIMH or the National Institutes of Health.

Funding

The National Institute of Mental Health (NIMH), under award number R01MH116768 funds Kyaterekera study (MPIs: Fred M. Ssewamala, PhD & Susan Witte, PhD).

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Authors and Affiliations

  1. International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA

    Joshua Kiyingi, Proscovia Nabunya, Samuel Kizito, Josephine Nabayinda, Ozge Sensoy Bahar, Jennifer Nattabi, Natasja Magorokosho & Fred M. Ssewamala

  2. International Center for Child Health and Development (ICHAD), Masaka, Uganda

    Edward Nsubuga & Flavia Namuwonge

  3. University of North Carolina Gillings School of Global Public Health, 170 Rosenau Hall, 27599, Chapel Hill, NC, USA

    Larissa Jennings Mayo-Wilson

  4. New York University College of Global Public Health, 14 East 4th street, 3rd floor, 10003, New York, NY, USA

    Yesim Tozan

  5. Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA

    Susan S. Witte

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  1. Joshua Kiyingi
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Contributions

FMS and SSW, conceptualized, received funding for the study and led and supervised all aspects of study implementation. PN, FMS and JK conceptualized the study. JK drafted the first manuscript and conducted data analysis. PN, SK, JN, OSB, LJMW, JN, NM, YT, SSW and FMS critically reviewed and contributed to manuscript revisions. EN and FN supervised data collection in the field. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Fred M. Ssewamala.

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The Institutional Review Boards of Washington University in St. Louis (#201811106), Columbia University Institutional Review Board (AAAR9804), Uganda Virus Research Institute Ethics Committee (GC/127/18/10/690) and Uganda National Council for Science and Technology (UNCST –SS4828) approved this study.

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Kiyingi, J., Nabunya, P., Kizito, S. et al. Self-Reported Adherence to Antiretroviral Therapy (ART) Among Women Engaged in Commercial Sex Work in Southern Uganda. AIDS Behav 27, 1004–1012 (2023). https://doi.org/10.1007/s10461-022-03837-9

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