ART adherence and associated factors among Female Sex Workers in Fort Portal, Mid- western Uganda: A cross-sectional study

ART adherence and associated factors among Female Sex Workers in Fort Portal, Mid- western Uganda: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article ART adherence and associated factors among Female Sex Workers in Fort Portal, Mid- western Uganda: A cross-sectional study David Friday Apuulison, Michael Muhoozi, Joshua Epuitai, Edson Katsomyo, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6403016/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Adherence to antiretroviral therapy (ART) is crucial for viral suppression and improved health outcomes among people with HIV. Female sex workers (FSWs) may face unique barriers to ART adherence, but data on their adherence levels and associated factors remain limited. The study was conducted to determine the level of ART adherence and associated factors among FSWs. Materials and methods A cross-sectional study was conducted in Fort portal City among 206 FSWs between July 2024 and August 2024. Interviewer-administered questionnaire was used to collect data on level of ART adherence and associated factors among female sex worker aged above 18 years and currently on ART using consecutive sampling method. ART adherence was assessed using self-reports and validated using records. Logistic regression was used to infer factors which were significantly associated with poor adherence to ART. Results In our study, 78% of the FSWs had good adherence (adherence >95%), 22% had ever stopped taking ART, while 14% had missed taking ART in the last two weeks from the study period. The main reasons for poor adherence were travelling/moving to a new place (32%), forgetfulness (29%), and food scarcity (13%), imprisonment (5.4%), hospital admission (5.4%), non-disclosure (5.4%), and side effects (5.4%). Experiencing Intimate Partner Violence (IPV)(aOR 2.59 (95% CI: 1.10-6.1) and having one child (aOR 8.69 (95% CI: 1.4-53.91) was significantly associated with poor adherence to ART among FSWs. Conclusion Our study indicates optimal ART adherence practices among FSWs. Poor adherence was associated with forgetfulness, food scarcity and travelling to a new place. Having one child and experiencing IPV significantly increased the odds of failing to adhere to ART medications. We recommend Measures that reinforce the Ugandan policy that aims at community mobilization and sensitization to both men and women about the dangers of IPV in relationships. Female sex workers adherence ART prevalence Background Globally, HIV/AIDs is still a public health concern, in 2024, 39.9 million infections and 630000 deaths were reported( 1 ).More than 55% of all new HIV infections in 2022 occurred among people from key populations and their sexual partners( 2 ). This encompasses female sex workers (FSW), men who engage in sexual activities with other men (MSM) and individuals who use injectable drugs(PWID).A systematic review conducted in Sub-Saharan Africa(SSA) showed that HIV among female sex workers, the incidence was almost eight times higher than that in the total female population( 3 ). In Uganda, the population of female sex workers (FSW) is estimated at about 130,000 women( 4 ). The overall prevalence of HIV among FSW is 33% which is higher than the national average of 6.5%( 5 , 6 ). Therefore, FSW are disproportionately affected by HIV. Fort portal was hit by the pandemic of HIV as the 1980s and was most severely affected areas in Uganda( 7 ), According to Ugandan HIV/AIDS fact sheet of 2024 Fort portal had a high HIV prevalence of 11.6% compared to other areas in Uganda( 8 ). The high prevalence of HIV could be linked to FSWs because they have a large number of sex partners, report infrequent condom use and also more likely to engage in high-risk sexual acts, and suboptimal ART adherence ( 9 ) The majority of the FSWs with HIV are aware of their status( 5 ), While 97% of those who are aware of their status are on antiretroviral therapy (ART), there is very low viral load testing (VL) at 62% with 91% VL suppression ( 5 , 10 ). Although a majority of FSW who are aware of their status are on ART, poor adherence to ART is more common among FSW than the general population( 11 ). Poor adherence is linked to treatment failure, suboptimal viral load suppression, risk of co-morbidities, increased hospitalization, poor quality of life and progression to Acquired immune deficiency syndrome (AIDS) ( 12 , 13 ). Ultimately, poor adherence to ART results in AIDS-related mortality( 11 ). ART adherence is relatively lower among FSW than the general population( 14 ). Globally, ART adherence among FSW varies from 50–90% in most settings( 15 ). In Uganda, 40% of FSWs were reported to miss their ART doses in the last three months, while 34% missed ART refill in the last 12 months at the time the study was conducted ( 5 ). The major reasons given for missing ART stem from food insecurity, substance abuse, incarceration, knowledge and beliefs( 16 ). Poor ART adherence is significantly associated with financial illiteracy, alcohol use, police incarceration and marital status( 17 ). Stigma, discrimination, depression and gender-based violence are significantly associated with increased risk of poor ART adherence( 18 , 19 ). While studies have been conducted in different cities, factors associated with poor adherence among FSW remain unclear in our setting ( 15 , 20 ). The study setting presents different dynamics related to a semi-urban city whose FSWs interface with a range of mobile populations and young adults and yet with the highest prevalence. Our study aimed to fill the knowledge gap by determining the magnitude of ART adherence and its associated factors among the FSWs in Fort Portal Tourism City. Methods and Materials Study Design and setting We conducted a cross-sectional study design to determine the level of ART adherence and its associated factors among FSWs between July, 2024 and August, 2024 in Fort Portal City, South Western Uganda.. Particularly, the study setting was Fort portal City which is one of the cities in Uganda with the highest prevalence of HIV at 17.8% far above the national average of 5.1% ( 21 ). Study population The study population was FSWs who were above 18 years of age. The sex workers were enrolled into the study if they were on ART. Sex workers who are not on ART were not eligible for the study. We used Cochran formula(1963;75) formula for cross-sectional studies, where n o was the estimated sample size of female sex workers with poor adherence practices, Z was the z score for 95% confidence interval equaling to 1.96, was the absolute error between the estimated and true population prevalence of MA (5%), We used a 50% proportion since the prevalence of adherence to ART among sex workers is not known that gave us a sample size of 385, considering the known population of sex workers as 500, we used a sample size reduction formula and we arrived at 217 participants of the 217 eligible women approached, 206 consented to participate, We enrolled 206 participants into the study. Consecutive sampling was used to select the participants for the study. Consecutive sampling involved enrolment of participants into the study as they came until the desired sample size was reached. Participants were recruited from their umbrella professional association of sex workers in the area. The umbrella associated had all the detailed information of all the FSW in the district. After identifying potential participants, individual women were reached out on phone to invite them to participate in the study. Individual interviews were scheduled with the FSW upon acceptance to be interviewed in a safe and private place. Data Collection tool Interviewer-administered questionnaires were used to collect data from the participants (supplementary materials). The questionnaire was developed based on previous validated instruments and was pre-tested among a small group of FSWs to ensure clarity and cultural appropriateness. It was translated into the local language (Rutooro) and back-translated to verify accuracy. The questionnaire consisted of questions about the socio-demographics (age, tribe, marital status, religion, level of education, level of income, and number of children), individual factors (substance use, awareness of HAART, beliefs and misconceptions about HIV/ART), interpersonal factors (social support, Intimate Partner Violence(IPV), disclosure of HIV status to partner/family members, HIV status of the partner), occupational factors (travels, number of sex partners, condom use, disclosure of HIV status) and structural factors (stigma, distance of ART clinics, ease of accessing ART drugs, poverty and food insecurity). Interviewers were trained on administering the questionnaire and ethical issues, and interviews were conducted in a private setting to ensure confidentiality and reduce social desirability bias. During the interviews the research assistants, who are nurses, were accompanied by a social scientist or a counsellor to provide social support for the participants in case of emotional breakdown. The interviews were conducted in the local language and it lasted about 5–15 minutes. Study variables The outcome variable was the level of ART adherence. We relied on women’s self-report to determine the level of ART adherence. These were validated using health facility level related records to confirm self-reports through checking received of ART for the period that was assessed. Previous studies have equally self-reports as a strategy to infer ART adherence among participants ( 22 – 24 ) The independent variables included socio-demographic factors, intrapersonal, interpersonal, occupational and structural factors. The socio-demographics included: age, tribe, marital status, religion, level of education, level of income, and number of children, while individual factors included substance use, awareness of ART, beliefs and misconceptions about HIV/ART. Interpersonal factors included social support, intimate partner violence, disclosure of HIV status to partner/family members, HIV status of the partner. Occupational factors included travels, number of sex partners, condom use, disclosure of HIV status, while structural factors included stigma, distance of ART clinics, ease of accessing ART drugs, poverty and food insecurity. Data management and analysis Data were entered into Kobo Collect data entry forms that were designed to control for poor quality data collection (using check questions and must fills), and then transferred to Stata version 14.0 (Stata corp) for cleaning and analysis. Data was collected with daily debrief meeting to ensure that there was no missing data and minimum data inaccuracies. Categorical variables were summarized using frequencies and percentages. Descriptive statistics included either mean (± SD) or median with the corresponding interquartile range for continuous variables. Bivariate logistic analyses were used to determine the association between the independent variables and the levels of ART adherence. Multivariate analysis was conducted for variables with a p-value of less than 0.2 at bivariate analysis and for plausible variables. A p-value of less than 0.05, odds ratios and corresponding confidence interval were used as a measure of association between the levels of adherence and the independent factors. Ethical consideration: The study obtained ethical clearance from the AIDS Support Organization (TASO) Research Ethics Committee. The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants before data collection. The participants received a modest compensation for their participant in the study. Results Socio-demographic characteristics. The majority of the FSW were between 28–37 years of age and were not married (Table 1 ). More than a half of the FSW were of primary level of education (51%), and had worked as sex workers for a more than a year. More than three-quarters (76%) of the FSW had HIV for more than four years (Table 1 ). Table 1 Description of the study participants. Age Frequency N = 206 Percentage 18–27 65 31.5 28–37 106 51.4 38–47 35 17.0 Marital status(n = 202) Married/cohabiting 31 15.3 Single/separated/widowed 171 84.7 Level of education (n = 201) No education 47 23.4 Primary 107 53.2 Secondary/Tertiary 47 23.3 Religion (n = 201) Christian 183 91.0 Muslim 18 8.0 Tribe (n = 198) Mutooro 161 81.3 Bakonjo 25 12.6 Banyankole 12 6.1 Number of children (n = 204) < 2 32 45.1 ≥ 2 112 54.9 Duration in sex work (n = 174) 6 months or less 26 14.94 1 year or less 42 24.14 More than 1 year 103 59.20 Duration with HIV (n = 196) 1–3 years 46 23.5 4 years or more 150 76.5 Adherence to ART among FSW in South-Western Uganda Adherence to ART was assessed using self-reports. This included questions on whether the FSW ever stopped taking ART drugs and whether FSW missed taking ART drugs at different time intervals. In our study, close to a quarter (22%) reported that they had ever stopped taking ART drugs (Table 2 ). FSW missed taking ART in the last two weeks, 14% missed in the last three months, and 7% reported missing ART in the last one year. Among those who stopped taking ART, the majority of them stopped ART for a month or less. The most common reasons for stopping ART drugs were attributed to travelling to a new place (32%), forgetfulness (29%), and unavailability of food (13%) (Table 2 ). Table 2 Level of ART adherence among FSW in South-Western Uganda ART adherence Frequency Percentage Ever stopped (n = 180) Yes 40 22.2 No 140 77.8 Duration of ever stopping ART (n = 48) A month or less 37 77.1 A year or more 11 22.9 Reasons for stopping ART Travelling or moving to a new place. 12 32.4 Forgetfulness 11 29.3 Food not available 5 13.5 Admitted in hospital 2 5.4 Imprisonment 2 5.4 Side effect ART drugs 2 5.4 Fear of partner or family member finding out 2 5.4 Busy at work 1 2.7 Missed ART in last 2 weeks (n = 106) Yes 16 15.1 No 90 84.9 Missed ART in last month (n = 71) Yes 8 11.3 No 63 88.7 Missed ART in last 3 months (n = 107) Yes 15 14.0 No 92 86.0 Missed ART in last 6 months (n = 71) Yes 6 8.5 No 65 91.5 Missed ART in last 12 months (n = 69) Yes 5 7.3 No 64 92.7 Factors associated with ART adherence among FSW. We conducted a bivariate and multivariate analyses to determine the factors which were associated with ART adherence among FSW. In the bivariate analyses, having one child, stigma and intimate partner violence were significantly associated increased odds of non-adherence to ART. FSW who had one child were more than four times more likely to stop adhering to ART medication compared to those with no children. FSW who reported experiencing stigma were more than two times likely to stop taking their ART medication compared to those who reported no experience stigma. Intimate partner violence significantly increased the odds ever stopping ART medications compared to those who did not experience intimate partner violence. After controlling all the variables, number of children and intimate partner violence remained as the only factors which were significantly associated with increased odds of non-adherence to ART. FSW with one child were more than eight times more likely to stop adhering to ART than FSW with no child. Experiencing intimate partner violence significantly increased the odds stopping ART drugs by more than two times compared to FSW who did not experience intimate partner violence (Table 3 ). Table 3 Bivariate and Multivariate analysis of the factors associated with poor adherence to ART Variable COR* (95% CI) p-value AOR* (95% CI) P-value Age 18–27 28–37 38–47 Ref 1.07 (0.48–2.37) 0.78 (0.28–2.15) 0.866 0.627 1.52(0.54–4.31) 1.34 (0.36–5.02) 0.429 0.661 Marital status Married Single/separated ref 1.91 (0.75–4.85) 0.176 Ref 3.15(0.86–11.52) 0.083 Level of education No education Primary Secondary/tertiary Ref 0.90(0.38–2.18) 1.03 (0.36–2.92) 0.824 0.955 Ref 0.96 (0.32–2.76) 1.22 (0.35–4.20) 0.922 0.753 Religion Christian Muslim Ref 0.59(0.19–1.81) 0.355 Ref 0.50(0.12–2.08) 0.342 Number of children 0 1 > 1 Ref 4.14(1.08–15.83) 0.96(0.37–2.54) 0.038** 0.943 Ref 8.69 (1.4-53.91) 0.92 (0.26–3.18) 0.020** 0.894 HIV duration < 5 years ≥ 5 years Ref 0.62 (.29-1.33) 0.221 Ref 0.59(0.23–1.53) 0.279 Distance to facility < 5km ≥ 5km Ref 1.20(0.56–2.58) 0.631 Ref 0.84 (0.33–2.14) 0.718 Pregnancy/childbirth in the last 12 months Yes No Ref 1.19(0.44–3.22) 0.738 Ref 1.27 (0.3504.64) 0.716 Serious adverse effects from HAART Yes No Ref 1.09(0.52–2.26) 0.817 Ref 0.97 (0.37–2.53) 0.958 Stigma Yes No Ref 2.13(1.04–4.35) 0.038* Ref 2.01 (0.82–4.94) 0.127 Mental health problems in the last 12 months Yes No Ref 1.33 (0.63–2.81) 0.451 Ref 1.46 (0.57–3.74) 0.427 Alcohol intake Yes No Ref 1.44(0.70–2.97) 0.321 Ref 1.37(0.54–3.47) 0.500 Substance abuse Yes No Ref 1.54 (0.70–3.39) 0.281 Ref 2.70 (0.97–7.51) 0.057 Disclosure of HIV status Yes No Ref 1.01 (0.31–3.25) 0.989 Ref 0.32 (0.06–1.59) 0.166 Family/partner support Yes No Ref 1.76(0.67–4.57) Ref 2.74 (0.84–8.89) 0.09 Condom use in last sexual encounter Yes No Ref 2.28 (0.97–5.33) 0.058 Ref 1.64 (0.5–4.47) 0.336 Intimate partner violence Yes No 2.98(1.44–6.17) 0.003** Ref 2.59 (1.10–6.1) 0.030** COR = crudes odds ratios; AOR = Adjusted odds ratios; Ref = reference **= statistically significant Discussion The study was conducted to determine ART adherence and its associated factors among FSWs in South-Western Uganda. Overall, self-reported adherence to ART was 85% in the last two weeks and 89% in the last month. Intimate partner violence and having a child was significantly associated with increased odds of failing to adhere to ART among FSW. In our study, ART adherence among FSW was 85% in the last two weeks and 89% in the last month. Our study findings are consistent with a scoping review finding which noted more than 80% adherence in the last two weeks and 50–67% in the last month across most sites( 15 ). In Dominican Republic, 28% of FSW had stopped taking ART in the last six months which was higher than the 15% reported in the last two weeks in our study( 12 ). ART adherence was noted to remain high when it was assessed using different methods (e.g., through use of pill counts) and when it was assessed at different periods (e.g., 12 months) in other studies( 15 ). In Burkina Faso, using pill counts, ART adherence among FSWs was 92% at 12 months and 100% at 36 months( 13 ). Our study notes high levels of adherence among FSW which may have positive implications in the reduction of HIV transmission and treatment outcomes among FSW populations. Forgetfulness, food scarcity, and travelling to a new place were the most common reasons given for missing or stopping to take ART among FSW. Our findings are consistent with previous studies that have noted challenges of ART adherence among FSW( 15 , 16 , 25 ). Our previous findings noted how unpredictability of sex work made women to forget to take their medicines( 26 ). Sex work also requires FSW to travel to new places to meet their clients which in the event of non-disclosure of their HIV status limits their freedom and ability to adhere to their ART( 16 , 27 ). Similar studies have noted poor adherence practices among FSW who were incarcerated which highlighted limited opportunities for ART adherence among FSW who have moved to new places( 15 ). Food scarcity was noted as one of the reasons for missing ART. Food scarcity may occur for several reasons emanating from poverty, having high number of dependents and limited income from sex work. FSW were counselled to eat food when taking their ART drugs which highlighted their tendency to stop or miss ART until food was available( 26 ). Providing adequate social support for FSW maybe critical in enabling them adhere to ART. The social support and acceptance may help in reminding FSW to take ART on time, support them to take medicines without stigmatizing or judging them, and provide food and other basic needs for FSW. FSW tend to have a heightened risk of experiencing intimate partner violence( 27 ). FSW are often beaten, assaulted and raped during their line of work( 27 ). In our study, FSW who were reported experiencing intimate partner violence were significantly more likely to report poor ART adherence. In Kenya, physical violence, sexual violence and controlling behaviors were found to significantly increase the odds of suboptimal ART adherence( 28 ). A similar qualitative study in Uganda cited gender-based violence as one of the perceived reasons for poor ART adherence( 26 ). Intimate partner violence is associated with adverse mental health outcomes including depression and suicidal ideations( 29 , 30 ). Consequently, FSW may often suffer from adverse mental health problems resulting in abandonment and poor adherence practices( 26 ). Study findings underscore the need to screen FSW for IPV during ART refills and the need to provide social support for victims of intimate partner violence( 28 ). This would help improve ART adherence among FSW who maybe suffering from IPV. Study limitations Our study provides insight on ART adherence among high-risk female sex worker population. The stigma related to HIV and sex work may have resulted in social desirability bias in reporting ART adherence. Despite the social desirability bias, our findings were comparable with studies that used pill counts to ascertain the level of ART adherence. Although we assessed ART during short period (e.g., adherence in the last two weeks), the findings may have been affected by recall bias. We used consecutive sampling which might have led to selection bias in our study. The power of the statistical tests could have influenced its ability to infer association among the study variables. Conclusion Our study noted optimal ART adherence practices among FSW. Travelling to a new place, forgetfulness and food scarcity were the most common reasons given for missing or failing to adhere to ART. Some of the FSW missed to take their medicines because of hospital admission, imprisonment, fear of family member finding out, busy work schedules and side effects of the drugs. Having a child and experiencing intimate partner violence was significantly associated with increased odds of failing to adhere to ART. Our study provides reasons and factors associated with failing to adhere to ART which if well addressed will improve ART among the FSW population. Declarations Acknowledgements We acknowledge the research participants, KWISH foundation and Mountains of the University for the Financial Assistance rendered to us. Funding The study received funding from the Mountains of the Moon University Research Innovation Fund (MMU-RIF) Author contributions DFA, BN, MM, JR Conceptualized and designed the study, collected data and wrote the manuscript, EK, PI, PA, CR, AM collected data and revised the manuscript, JE, GW analyzed the data, BN supervised the study and reviewed the manuscript. Corresponding Author David Friday Apuulison Ethical declarations Ethics approval and consent to participate Ethical approval was sought from the AIDS Support Organization Research (TASO-REC) approval number 2024-339. All participants provided written informed consent before data collection; the study was done based on the ethical principles of Helsinki. Consent for publication The authors consent to the publication Competing interests The authors declare no competing interests Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References UNAIDS. UNAIDS Fact sheet. 2024. UNAIDS. New HIVinfections data among key populations:proportions in 2010 and 2022. 2024. Jones HS, Anderson RL, Cust H, McClelland RS, Richardson BA, Thirumurthy H, et al. HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis. 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African Journal of Midwifery and Women's Health. 2019;13(2):1-5. Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. The Lancet. 2008;371(9619):1165-72. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6403016","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451010394,"identity":"adce6301-f5bf-45e4-963b-5e3d7569455b","order_by":0,"name":"David Friday Apuulison","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYLCCBwZAgr0BSBhYEKklAaSF5wBIiwSxWkCEBIQkrJp/do+ZREJBnZy55POrG34USDDwt3cn4NUicecMUIvBYWPL2TllN3uADpM4c3YDfmtu5IC0HEjccDsn7QYPUIuBRC5+LfIQLXWJG26eSbv5hxgtBhAtzIkbbrAfu02ULYZ3jhVbgPxicCaH7baMgQQPQb/I3W7eeOPDnzo5g+PHn91888dGjr+9l4D3ERHBYwAm8StH1cL+gLDqUTAKRsEoGJEAAIxgR2KxKwK1AAAAAElFTkSuQmCC","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"Friday","lastName":"Apuulison","suffix":""},{"id":451010395,"identity":"7b3043c2-0b97-4570-a6eb-1849af3a1b3c","order_by":1,"name":"Michael Muhoozi","email":"","orcid":"","institution":"Makerere University Center for Health and Population Research","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Muhoozi","suffix":""},{"id":451010396,"identity":"07fce9e9-059b-4258-8172-a5ad08bb3b6d","order_by":2,"name":"Joshua Epuitai","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Epuitai","suffix":""},{"id":451010398,"identity":"e84be77d-ae94-4474-bf83-3768010e97d1","order_by":3,"name":"Edson Katsomyo","email":"","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":false,"prefix":"","firstName":"Edson","middleName":"","lastName":"Katsomyo","suffix":""},{"id":451010399,"identity":"ce4571ba-fb46-46df-aa06-d80cc02e01e3","order_by":4,"name":"Pauline Irumba","email":"","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":false,"prefix":"","firstName":"Pauline","middleName":"","lastName":"Irumba","suffix":""},{"id":451010400,"identity":"afdca15c-3ddd-49b2-911f-0786232248f7","order_by":5,"name":"Pardon Akugizibwe","email":"","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":false,"prefix":"","firstName":"Pardon","middleName":"","lastName":"Akugizibwe","suffix":""},{"id":451010402,"identity":"20beee0e-9f71-443b-aa18-f7976f839af1","order_by":6,"name":"Charles Rugumayo","email":"","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"","lastName":"Rugumayo","suffix":""},{"id":451010403,"identity":"40c98e61-c8ac-417d-b35f-fc55aed86cd7","order_by":7,"name":"Moses Asiimwe","email":"","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":false,"prefix":"","firstName":"Moses","middleName":"","lastName":"Asiimwe","suffix":""},{"id":451010404,"identity":"b0a71bc8-9339-4442-a59a-5c5a7eafba5a","order_by":8,"name":"George Wasswa","email":"","orcid":"","institution":"Fort portal Regional Referral Hospital","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Wasswa","suffix":""},{"id":451010405,"identity":"849cd748-6603-40ed-ae89-bb1595532b16","order_by":9,"name":"John Rubaihayo","email":"","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Rubaihayo","suffix":""},{"id":451010406,"identity":"f588c3f7-fde5-42b0-9eb6-be133da69d23","order_by":10,"name":"Brenda Nabawanuka","email":"","orcid":"","institution":"Mountains of the Moon University","correspondingAuthor":false,"prefix":"","firstName":"Brenda","middleName":"","lastName":"Nabawanuka","suffix":""}],"badges":[],"createdAt":"2025-04-08 11:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6403016/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6403016/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84591111,"identity":"c6c94706-1092-410f-8e18-8503e9fd75c9","added_by":"auto","created_at":"2025-06-14 02:46:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":903207,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6403016/v1/f089ef27-e4a0-4e1a-aea4-6ac105e790ae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"ART adherence and associated factors among Female Sex Workers in Fort Portal, Mid- western Uganda: A cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobally, HIV/AIDs is still a public health concern, in 2024, 39.9\u0026nbsp;million infections and 630000 deaths were reported(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).More than 55% of all new HIV infections in 2022 occurred among people from key populations and their sexual partners(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This encompasses female sex workers (FSW), men who engage in sexual activities with other men (MSM) and individuals who use injectable drugs(PWID).A systematic review conducted in Sub-Saharan Africa(SSA) showed that HIV among female sex workers, the incidence was almost eight times higher than that in the total female population(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Uganda, the population of female sex workers (FSW) is estimated at about 130,000 women(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The overall prevalence of HIV among FSW is 33% which is higher than the national average of 6.5%(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Therefore, FSW are disproportionately affected by HIV.\u003c/p\u003e \u003cp\u003eFort portal was hit by the pandemic of HIV as the 1980s and was most severely affected areas in Uganda(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), According to Ugandan HIV/AIDS fact sheet of 2024 Fort portal had a high HIV prevalence of 11.6% compared to other areas in Uganda(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The high prevalence of HIV could be linked to FSWs because they have a large number of sex partners, report infrequent condom use and also more likely to engage in high-risk sexual acts, and suboptimal ART adherence (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe majority of the FSWs with HIV are aware of their status(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), While 97% of those who are aware of their status are on antiretroviral therapy (ART), there is very low viral load testing (VL) at 62% with 91% VL suppression (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Although a majority of FSW who are aware of their status are on ART, poor adherence to ART is more common among FSW than the general population(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Poor adherence is linked to treatment failure, suboptimal viral load suppression, risk of co-morbidities, increased hospitalization, poor quality of life and progression to Acquired immune deficiency syndrome (AIDS) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Ultimately, poor adherence to ART results in AIDS-related mortality(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eART adherence is relatively lower among FSW than the general population(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Globally, ART adherence among FSW varies from 50\u0026ndash;90% in most settings(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Uganda, 40% of FSWs were reported to miss their ART doses in the last three months, while 34% missed ART refill in the last 12 months at the time the study was conducted (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The major reasons given for missing ART stem from food insecurity, substance abuse, incarceration, knowledge and beliefs(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Poor ART adherence is significantly associated with financial illiteracy, alcohol use, police incarceration and marital status(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Stigma, discrimination, depression and gender-based violence are significantly associated with increased risk of poor ART adherence(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). While studies have been conducted in different cities, factors associated with poor adherence among FSW remain unclear in our setting (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The study setting presents different dynamics related to a semi-urban city whose FSWs interface with a range of mobile populations and young adults and yet with the highest prevalence. Our study aimed to fill the knowledge gap by determining the magnitude of ART adherence and its associated factors among the FSWs in Fort Portal Tourism City.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and setting\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study design to determine the level of ART adherence and its associated factors among FSWs between July, 2024 and August, 2024 in Fort Portal City, South Western Uganda.. Particularly, the study setting was Fort portal City which is one of the cities in Uganda with the highest prevalence of HIV at 17.8% far above the national average of 5.1% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population was FSWs who were above 18 years of age. The sex workers were enrolled into the study if they were on ART. Sex workers who are not on ART were not eligible for the study. We used Cochran formula(1963;75) formula for cross-sectional studies, where n\u003csub\u003eo\u003c/sub\u003e was the estimated sample size of female sex workers with poor adherence practices, Z was the z score for 95% confidence interval equaling to 1.96, was the absolute error between the estimated and true population prevalence of MA (5%), We used a 50% proportion since the prevalence of adherence to ART among sex workers is not known that gave us a sample size of 385, considering the known population of sex workers as 500, we used a sample size reduction formula and we arrived at 217 participants of the 217 eligible women approached, 206 consented to participate, We enrolled 206 participants into the study. Consecutive sampling was used to select the participants for the study. Consecutive sampling involved enrolment of participants into the study as they came until the desired sample size was reached. Participants were recruited from their umbrella professional association of sex workers in the area. The umbrella associated had all the detailed information of all the FSW in the district. After identifying potential participants, individual women were reached out on phone to invite them to participate in the study. Individual interviews were scheduled with the FSW upon acceptance to be interviewed in a safe and private place.\u003c/p\u003e\n\u003ch3\u003eData Collection tool\u003c/h3\u003e\n\u003cp\u003eInterviewer-administered questionnaires were used to collect data from the participants (supplementary materials). The questionnaire was developed based on previous validated instruments and was pre-tested among a small group of FSWs to ensure clarity and cultural appropriateness. It was translated into the local language (Rutooro) and back-translated to verify accuracy. The questionnaire consisted of questions about the socio-demographics (age, tribe, marital status, religion, level of education, level of income, and number of children), individual factors (substance use, awareness of HAART, beliefs and misconceptions about HIV/ART), interpersonal factors (social support, Intimate Partner Violence(IPV), disclosure of HIV status to partner/family members, HIV status of the partner), occupational factors (travels, number of sex partners, condom use, disclosure of HIV status) and structural factors (stigma, distance of ART clinics, ease of accessing ART drugs, poverty and food insecurity). Interviewers were trained on administering the questionnaire and ethical issues, and interviews were conducted in a private setting to ensure confidentiality and reduce social desirability bias. During the interviews the research assistants, who are nurses, were accompanied by a social scientist or a counsellor to provide social support for the participants in case of emotional breakdown. The interviews were conducted in the local language and it lasted about 5\u0026ndash;15 minutes.\u003c/p\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cp\u003eThe outcome variable was the level of ART adherence. We relied on women\u0026rsquo;s self-report to determine the level of ART adherence. These were validated using health facility level related records to confirm self-reports through checking received of ART for the period that was assessed. Previous studies have equally self-reports as a strategy to infer ART adherence among participants (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe independent variables included socio-demographic factors, intrapersonal, interpersonal, occupational and structural factors. The socio-demographics included: age, tribe, marital status, religion, level of education, level of income, and number of children, while individual factors included substance use, awareness of ART, beliefs and misconceptions about HIV/ART. Interpersonal factors included social support, intimate partner violence, disclosure of HIV status to partner/family members, HIV status of the partner. Occupational factors included travels, number of sex partners, condom use, disclosure of HIV status, while structural factors included stigma, distance of ART clinics, ease of accessing ART drugs, poverty and food insecurity.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eData were entered into Kobo Collect data entry forms that were designed to control for poor quality data collection (using check questions and must fills), and then transferred to Stata version 14.0 (Stata corp) for cleaning and analysis. Data was collected with daily debrief meeting to ensure that there was no missing data and minimum data inaccuracies. Categorical variables were summarized using frequencies and percentages. Descriptive statistics included either mean (\u0026plusmn;\u0026thinsp;SD) or median with the corresponding interquartile range for continuous variables. Bivariate logistic analyses were used to determine the association between the independent variables and the levels of ART adherence. Multivariate analysis was conducted for variables with a p-value of less than 0.2 at bivariate analysis and for plausible variables. A p-value of less than 0.05, odds ratios and corresponding confidence interval were used as a measure of association between the levels of adherence and the independent factors.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration:\u003c/h2\u003e \u003cp\u003eThe study obtained ethical clearance from the AIDS Support Organization (TASO) Research Ethics Committee. The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants before data collection. The participants received a modest compensation for their participant in the study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eSocio-demographic characteristics.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe majority of the FSW were between 28\u0026ndash;37 years of age and were not married (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). More than a half of the FSW were of primary level of education (51%), and had worked as sex workers for a more than a year. More than three-quarters (76%) of the FSW had HIV for more than four years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the study participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency N\u0026thinsp;=\u0026thinsp;206\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u0026ndash;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38\u0026ndash;47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMarital status(n\u0026thinsp;=\u0026thinsp;202)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle/separated/widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eLevel of education (n\u0026thinsp;=\u0026thinsp;201)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary/Tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eReligion (n\u0026thinsp;=\u0026thinsp;201)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTribe (n\u0026thinsp;=\u0026thinsp;198)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMutooro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBakonjo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBanyankole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNumber of children (n\u0026thinsp;=\u0026thinsp;204)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDuration in sex work (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 year or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDuration with HIV (n\u0026thinsp;=\u0026thinsp;196)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 years or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAdherence to ART among FSW in South-Western Uganda\u003c/h3\u003e\n\u003cp\u003eAdherence to ART was assessed using self-reports. This included questions on whether the FSW ever stopped taking ART drugs and whether FSW missed taking ART drugs at different time intervals. In our study, close to a quarter (22%) reported that they had ever stopped taking ART drugs (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). FSW missed taking ART in the last two weeks, 14% missed in the last three months, and 7% reported missing ART in the last one year. Among those who stopped taking ART, the majority of them stopped ART for a month or less. The most common reasons for stopping ART drugs were attributed to travelling to a new place (32%), forgetfulness (29%), and unavailability of food (13%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLevel of ART adherence among FSW in South-Western Uganda\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART adherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eEver stopped (n\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of ever stopping ART (n\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA month or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA year or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eReasons for stopping ART\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravelling or moving to a new place.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForgetfulness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood not available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmitted in hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImprisonment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide effect ART drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of partner or family member finding out\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusy at work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMissed ART in last 2 weeks (n\u0026thinsp;=\u0026thinsp;106)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMissed ART in last month (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMissed ART in last 3 months (n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMissed ART in last 6 months (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMissed ART in last 12 months (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with ART adherence among FSW.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe conducted a bivariate and multivariate analyses to determine the factors which were associated with ART adherence among FSW. In the bivariate analyses, having one child, stigma and intimate partner violence were significantly associated increased odds of non-adherence to ART. FSW who had one child were more than four times more likely to stop adhering to ART medication compared to those with no children. FSW who reported experiencing stigma were more than two times likely to stop taking their ART medication compared to those who reported no experience stigma. Intimate partner violence significantly increased the odds ever stopping ART medications compared to those who did not experience intimate partner violence. After controlling all the variables, number of children and intimate partner violence remained as the only factors which were significantly associated with increased odds of non-adherence to ART. FSW with one child were more than eight times more likely to stop adhering to ART than FSW with no child. Experiencing intimate partner violence significantly increased the odds stopping ART drugs by more than two times compared to FSW who did not experience intimate partner violence (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate and Multivariate analysis of the factors associated with poor adherence to ART\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOR* (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR* (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e18\u0026ndash;27\u003c/p\u003e \u003cp\u003e28\u0026ndash;37\u003c/p\u003e \u003cp\u003e38\u0026ndash;47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.07 (0.48\u0026ndash;2.37)\u003c/p\u003e \u003cp\u003e0.78 (0.28\u0026ndash;2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.52(0.54\u0026ndash;4.31)\u003c/p\u003e \u003cp\u003e1.34 (0.36\u0026ndash;5.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eSingle/separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003cp\u003e1.91 (0.75\u0026ndash;4.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e3.15(0.86\u0026ndash;11.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003cp\u003eNo education\u003c/p\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary/tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.90(0.38\u0026ndash;2.18)\u003c/p\u003e \u003cp\u003e1.03 (0.36\u0026ndash;2.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.96 (0.32\u0026ndash;2.76)\u003c/p\u003e \u003cp\u003e1.22 (0.35\u0026ndash;4.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003cp\u003eChristian\u003c/p\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.59(0.19\u0026ndash;1.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.50(0.12\u0026ndash;2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e4.14(1.08\u0026ndash;15.83)\u003c/p\u003e \u003cp\u003e0.96(0.37\u0026ndash;2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.038**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e8.69 (1.4-53.91)\u003c/p\u003e \u003cp\u003e0.92 (0.26\u0026ndash;3.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.020**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV duration\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.62 (.29-1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.59(0.23\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to facility\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5km\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.20(0.56\u0026ndash;2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.84 (0.33\u0026ndash;2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy/childbirth in the last 12 months\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.19(0.44\u0026ndash;3.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.27 (0.3504.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerious adverse effects from HAART\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.09(0.52\u0026ndash;2.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.97 (0.37\u0026ndash;2.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStigma\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e2.13(1.04\u0026ndash;4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.038*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e2.01 (0.82\u0026ndash;4.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental health problems in the last 12 months\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.33 (0.63\u0026ndash;2.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.46 (0.57\u0026ndash;3.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol intake\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.44(0.70\u0026ndash;2.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.37(0.54\u0026ndash;3.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubstance abuse\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.54 (0.70\u0026ndash;3.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e2.70 (0.97\u0026ndash;7.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisclosure of HIV status\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.01 (0.31\u0026ndash;3.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e0.32 (0.06\u0026ndash;1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily/partner support\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.76(0.67\u0026ndash;4.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e2.74 (0.84\u0026ndash;8.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondom use in last sexual encounter\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e2.28 (0.97\u0026ndash;5.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.64 (0.5\u0026ndash;4.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntimate partner violence\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.98(1.44\u0026ndash;6.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.003**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e2.59 (1.10\u0026ndash;6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.030**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCOR\u0026thinsp;=\u0026thinsp;crudes odds ratios; AOR\u0026thinsp;=\u0026thinsp;Adjusted odds ratios; Ref\u0026thinsp;=\u0026thinsp;reference **= statistically significant\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study was conducted to determine ART adherence and its associated factors among FSWs in South-Western Uganda. Overall, self-reported adherence to ART was 85% in the last two weeks and 89% in the last month. Intimate partner violence and having a child was significantly associated with increased odds of failing to adhere to ART among FSW.\u003c/p\u003e \u003cp\u003eIn our study, ART adherence among FSW was 85% in the last two weeks and 89% in the last month. Our study findings are consistent with a scoping review finding which noted more than 80% adherence in the last two weeks and 50\u0026ndash;67% in the last month across most sites(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Dominican Republic, 28% of FSW had stopped taking ART in the last six months which was higher than the 15% reported in the last two weeks in our study(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). ART adherence was noted to remain high when it was assessed using different methods (e.g., through use of pill counts) and when it was assessed at different periods (e.g., 12 months) in other studies(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Burkina Faso, using pill counts, ART adherence among FSWs was 92% at 12 months and 100% at 36 months(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Our study notes high levels of adherence among FSW which may have positive implications in the reduction of HIV transmission and treatment outcomes among FSW populations.\u003c/p\u003e \u003cp\u003eForgetfulness, food scarcity, and travelling to a new place were the most common reasons given for missing or stopping to take ART among FSW. Our findings are consistent with previous studies that have noted challenges of ART adherence among FSW(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Our previous findings noted how unpredictability of sex work made women to forget to take their medicines(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Sex work also requires FSW to travel to new places to meet their clients which in the event of non-disclosure of their HIV status limits their freedom and ability to adhere to their ART(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Similar studies have noted poor adherence practices among FSW who were incarcerated which highlighted limited opportunities for ART adherence among FSW who have moved to new places(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Food scarcity was noted as one of the reasons for missing ART. Food scarcity may occur for several reasons emanating from poverty, having high number of dependents and limited income from sex work. FSW were counselled to eat food when taking their ART drugs which highlighted their tendency to stop or miss ART until food was available(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Providing adequate social support for FSW maybe critical in enabling them adhere to ART. The social support and acceptance may help in reminding FSW to take ART on time, support them to take medicines without stigmatizing or judging them, and provide food and other basic needs for FSW.\u003c/p\u003e \u003cp\u003eFSW tend to have a heightened risk of experiencing intimate partner violence(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). FSW are often beaten, assaulted and raped during their line of work(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In our study, FSW who were reported experiencing intimate partner violence were significantly more likely to report poor ART adherence. In Kenya, physical violence, sexual violence and controlling behaviors were found to significantly increase the odds of suboptimal ART adherence(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). A similar qualitative study in Uganda cited gender-based violence as one of the perceived reasons for poor ART adherence(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Intimate partner violence is associated with adverse mental health outcomes including depression and suicidal ideations(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Consequently, FSW may often suffer from adverse mental health problems resulting in abandonment and poor adherence practices(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Study findings underscore the need to screen FSW for IPV during ART refills and the need to provide social support for victims of intimate partner violence(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This would help improve ART adherence among FSW who maybe suffering from IPV.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eOur study provides insight on ART adherence among high-risk female sex worker population. The stigma related to HIV and sex work may have resulted in social desirability bias in reporting ART adherence. Despite the social desirability bias, our findings were comparable with studies that used pill counts to ascertain the level of ART adherence. Although we assessed ART during short period (e.g., adherence in the last two weeks), the findings may have been affected by recall bias. We used consecutive sampling which might have led to selection bias in our study. The power of the statistical tests could have influenced its ability to infer association among the study variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study noted optimal ART adherence practices among FSW. Travelling to a new place, forgetfulness and food scarcity were the most common reasons given for missing or failing to adhere to ART. Some of the FSW missed to take their medicines because of hospital admission, imprisonment, fear of family member finding out, busy work schedules and side effects of the drugs. Having a child and experiencing intimate partner violence was significantly associated with increased odds of failing to adhere to ART. Our study provides reasons and factors associated with failing to adhere to ART which if well addressed will improve ART among the FSW population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the research participants, KWISH foundation and Mountains of the University for the Financial Assistance rendered to us.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received funding from the Mountains of the Moon University Research Innovation Fund (MMU-RIF)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDFA, BN, MM, JR \u0026nbsp;Conceptualized and designed the study, collected data and wrote the manuscript, EK, PI, PA, CR, AM collected data and revised the manuscript, JE, GW analyzed the data, BN supervised the study and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDavid Friday Apuulison\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical declarations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval was sought from the AIDS Support Organization Research (TASO-REC) approval number 2024-339. All participants provided written informed consent before data collection; the study was done based on the ethical principles of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors consent to the publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUNAIDS. UNAIDS Fact sheet. 2024.\u003c/li\u003e\n\u003cli\u003eUNAIDS. New HIVinfections data among key populations:proportions in 2010 and 2022. 2024.\u003c/li\u003e\n\u003cli\u003eJones HS, Anderson RL, Cust H, McClelland RS, Richardson BA, Thirumurthy H, et al. HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis. The Lancet Global Health. 2024;12(8):e1244-e60.\u003c/li\u003e\n\u003cli\u003eMakerere University School of Public Health, Uganda HIV\u0026amp;AIDS Legal environment assessment for keypopulations, August 2022, \u003c/li\u003e\n\u003cli\u003eMakerere University, School of Public Health. Bio- Behavioral Survey among Female Sex Workers in 12 districts in Uganda. 2021 \u0026ndash; 2023.\u003c/li\u003e\n\u003cli\u003eUganda AIDS Commission; Ministry of Health \u0026amp; UNAIDS (2023). Uganda HIV \u0026amp; AIDS FactSheet (Based on data ending on December 2022). https://uac.go.ug/index.php?option=com_sppagebuilder\u0026amp;view=page\u0026amp;id=24\u0026amp;Itemid=140. Last accessed on 01/06/2024.\u003c/li\u003e\n\u003cli\u003eRubaihayo J, Akib S, Mughusu E, Abaasa A. High HIV prevalence and associated factors in a remote community in the Rwenzori region of Western Uganda. Infectious Disease Reports. 2010;2(2):e13.\u003c/li\u003e\n\u003cli\u003eCOMMISSION UA. UGANDA HIV AND AIDS FACTSHEET 2024.\u003c/li\u003e\n\u003cli\u003ePaz-Bailey G, Noble M, Salo K, Tregear SJ. Prevalence of HIV among US female sex workers: systematic review and meta-analysis. AIDS and Behavior. 2016;20:2318-31.\u003c/li\u003e\n\u003cli\u003eAtuhaire L, Shumba CS, Mapahla L, Nyasulu PS. A retrospective cross sectional study assessing factors associated with retention and non-viral suppression among HIV positive FSWs receiving antiretroviral therapy from primary health care facilities in Kampala, Uganda. BMC Infectious Diseases. 2022;22(1):642.\u003c/li\u003e\n\u003cli\u003eComins CA, Baral S, Mcingana M, Shipp L, Phetlhu DR, Young K, et al. ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study. PLOS Global Public Health. 2024;4(5):e0002783.\u003c/li\u003e\n\u003cli\u003eKerrigan D, Barrington C, Donastorg Y, Perez M, Gomez H, Davis W, et al. Individual and collective forms of stigma resistance: pathways between HIV and sex work stigma and viral suppression among female sex workers in the Dominican Republic. AIDS and Behavior. 2024;28(1):357-66.\u003c/li\u003e\n\u003cli\u003eHuet C, Ouedraogo A, Konat\u0026eacute; I, Traore I, Rouet F, Kabor\u0026eacute; A, et al. Long term virological, immunological and mortality outcomes in a cohort of HIV-infected female sex workers treated with highly active antiretroviral therapy in Africa. BMC public health. 2011;11:1-10.\u003c/li\u003e\n\u003cli\u003eMountain E, Mishra S, Vickerman P, Pickles M, Gilks C, Boily M-C. Antiretroviral therapy uptake, attrition, adherence and outcomes among HIV-infected female sex workers: a systematic review and meta-analysis. PLoS One. 2014;9(9):e105645.\u003c/li\u003e\n\u003cli\u003eGlick JL, Russo RG, Huang AK-H, Jivapong B, Ramasamy V, Rosman LM, et al. ART uptake and adherence among female sex workers (FSW) globally: A scoping review. Global public health. 2022;17(2):254-84.\u003c/li\u003e\n\u003cli\u003eParmley LE, Comins CA, Young K, Mcingana M, Phetlhu DR, Guddera V, et al. Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa. Occupational and environmental medicine. 2020;77(2):100-6.\u003c/li\u003e\n\u003cli\u003eKiyingi J, Nabunya P, Kizito S, Nabayinda J, Nsubuga E, Bahar OS, et al. Self-reported adherence to antiretroviral therapy (ART) among women engaged in commercial sex work in southern Uganda. AIDS and Behavior. 2023;27(3):1004-12.\u003c/li\u003e\n\u003cli\u003eWang Y, Karver TS, Berg CJ, Barrington C, Donastorg Y, Perez M, et al. Substance use and depression impede ART adherence among female sex workers living with HIV in the Dominican Republic. AIDS and Behavior. 2023;27(7):2079-88.\u003c/li\u003e\n\u003cli\u003eZeleke TA, Alemu K, Ayele TA, Denu ZA, Mwanri L, Azale T. Systematic review and meta-analysis on the effect of depression on ART adherence among women living with HIV. PLoS One. 2024;19(6):e0300106.\u003c/li\u003e\n\u003cli\u003eWanyenze RK, Musinguzi G, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J, et al. \u0026ldquo;When they know that you are a sex worker, you will be the last person to be treated\u0026rdquo;: perceptions and experiences of female sex workers in accessing HIV services in Uganda. BMC international health and human rights. 2017;17:1-11.\u003c/li\u003e\n\u003cli\u003eCommission UA. Annual Joint AIDS Review Report 2022/2023. Available from: https://uac.go.ug/images/2024/jar-2024/jar-2022-2023-annual-report.pdf.\u003c/li\u003e\n\u003cli\u003eBrathwaite R, Ssewamala FM, Neilands TB, Okumu M, Mutumba M, Damulira C, et al. Predicting the individualized risk of poor adherence to ART medication among adolescents living with HIV in Uganda: the Suubi+ Adherence study. African Journal of Reproduction and Gynaecological Endoscopy. 2021;24(6):e25756.\u003c/li\u003e\n\u003cli\u003eSsemakula DM, Balinda SN, Mayanja Y, Kamacooko O, Abaasa A, Seeley J. Adherence to antiretroviral therapy among Female Sex Workers in Kampala Uganda. medRxiv. 2025:2025.03. 19.25324247.\u003c/li\u003e\n\u003cli\u003eAbaasa AM, Todd J, Ekoru K, Kalyango JN, Levin J, Odeke E, et al. Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda. BMC health services research. 2008;8:1-10.\u003c/li\u003e\n\u003cli\u003eIsabirye R, Opii DJ, Opio Ekit S, Kawomera A, Lokiru L, Isoke R, et al. Factors influencing ART adherence among persons living with HIV enrolled in community client-led art delivery groups in Lira District, Uganda: A qualitative study. HIV/AIDS-Research and Palliative Care. 2023:339-47.\u003c/li\u003e\n\u003cli\u003eApuulison DF, Nabawanuka B, Muhoozi M, Aryampa J, Irumba P, Katsomyo E, et al. Enablers of and barriers to ART adherence among female sex workers in mid-western Uganda: a qualitative study. AIDS Research and Therapy. 2025;22(1):4.\u003c/li\u003e\n\u003cli\u003eKatumba KR, Haumba M, Mayanja Y, Machira YW, Gafos M, Quaife M, et al. Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study. BMC Women\u0026apos;s Health. 2024;24(1):371.\u003c/li\u003e\n\u003cli\u003eBiomndo BC, Bergmann A, Lahmann N, Atwoli L. Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya. PLoS One. 2021;16(4):e0249813.\u003c/li\u003e\n\u003cli\u003eEpuitai J, Udho S, Auma AG, Nabirye RC. Intimate partner violence among pregnant women in Uganda. African Journal of Midwifery and Women\u0026apos;s Health. 2019;13(2):1-5.\u003c/li\u003e\n\u003cli\u003eEllsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women\u0026apos;s physical and mental health in the WHO multi-country study on women\u0026apos;s health and domestic violence: an observational study. The Lancet. 2008;371(9619):1165-72.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Female sex workers, adherence, ART, prevalence","lastPublishedDoi":"10.21203/rs.3.rs-6403016/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6403016/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Adherence to antiretroviral therapy (ART) is crucial for viral suppression and improved health outcomes among people with HIV. Female sex workers (FSWs) may face unique barriers to ART adherence, but data on their adherence levels and associated factors remain limited. The study was conducted to determine the level of ART adherence and associated factors among FSWs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted in Fort portal City among 206 FSWs between July 2024 and August 2024. Interviewer-administered questionnaire was used to collect data on level of ART adherence and associated factors among female sex worker aged above 18 years and currently on ART using consecutive sampling method. ART adherence was assessed using self-reports and validated using records. Logistic regression was used to infer factors which were significantly associated with poor adherence to ART.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, 78% of the FSWs had good adherence (adherence \u0026gt;95%), 22% had ever stopped taking ART, while 14% had missed taking ART in the last two weeks from the study period. The main reasons for poor adherence were travelling/moving to a new place (32%), forgetfulness (29%), and food scarcity (13%), imprisonment (5.4%), hospital admission (5.4%), non-disclosure (5.4%), and side effects (5.4%). Experiencing Intimate Partner Violence (IPV)(aOR 2.59 (95% CI: 1.10-6.1) and having one child (aOR 8.69 (95% CI: 1.4-53.91) was significantly associated with poor adherence to ART among FSWs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study indicates optimal ART adherence practices among FSWs. Poor adherence was associated with forgetfulness, food scarcity and travelling to a new place. Having one child and experiencing IPV significantly increased the odds of failing to adhere to ART medications. We recommend Measures that reinforce the Ugandan policy that aims at community mobilization and sensitization to both men and women about the dangers of IPV in relationships.\u003c/p\u003e","manuscriptTitle":"ART adherence and associated factors among Female Sex Workers in Fort Portal, Mid- western Uganda: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 16:52:05","doi":"10.21203/rs.3.rs-6403016/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb2e83c3-49c2-4ecc-bc8a-cc3f0d1b67ae","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-14T02:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-06 16:52:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6403016","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6403016","identity":"rs-6403016","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}