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Missed Study Visits and Subsequent HIV Incidence Among Women in a Predominantly Sex Worker Cohort Attending a Dedicated Clinic Service in Kampala, Uganda

Kasamba, Ivan MSca,b; Nash, Stephen MScb,c; Shahmanesh, Maryam PhDd; Baisley, Kathy MScb; Todd, Jim MScb; Kamacooko, Onesmus MSca; Mayanja, Yunia MSca; Seeley, Janet PhDa,b; Weiss, Helen A. PhDb,c

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2019 - Volume 82 - Issue 4 - p 343–354
doi: 10.1097/QAI.0000000000002143

Background: There is limited evidence on the relationship between sustained exposure of female sex workers (FSWs) to targeted HIV programmes and HIV incidence. We investigate the relationship between the number of missed study visits (MSVs) within each episode of 2 consecutively attended visits (MSVs) and subsequent HIV risk in a predominantly FSW cohort.

Methods: Women at high risk of HIV are invited to attend an ongoing dedicated clinic offering a combination HIV prevention intervention in Kampala, Uganda. Study visits are scheduled once every 3 months. The analysis included HIV-seronegative women with ≥1 follow-up visit from enrollment (between April 2008 and May 2017) to August 2017. Cox regression models were fitted adjusted for characteristics on sociodemographic, reproductive, behavioral, and sexually transmitted infections (through clinical examination and serological testing for syphilis).

Findings: Among 2206 participants, HIV incidence was 3.1/100 (170/5540) person-years [95% confidence interval (CI): 2.6 to 3.5]. Incidence increased from 2.6/100 person-years (95% CI: 2.1 to 3.2) in episodes without a MSV to 3.0/100 (95% CI: 2.2 to 4.1) for 1–2 MSVs and 4.3/100 (95% CI: 3.3 to 5.6) for ≥3 MSVs. Relative to episodes without a MSV, the hazard ratios (adjusted for confounding variables) were 1.40 (95% CI: 0.93 to 2.12) for 1–2 MSVs and 2.00 (95% CI: 1.35 to 2.95) for ≥3 MSVs (P-trend = 0.001).

Conclusion: Missing study visits was associated with increased subsequent HIV risk. Although several factors may underlie this association, the finding suggests effectiveness of targeted combination HIV prevention. But exposure to targeted interventions needs to be monitored, facilitated, and sustained in FSWs.

aMRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda;

bLondon School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom;

cMRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom; and

dInstitute for Global Health, University College London, London, United Kingdom.

Correspondence to: Ivan Kasamba, MSc, MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Uganda (e-mail:

Supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement (K012126/1). The clinic receives support from PEPFAR through the Centres for Disease Control and Prevention for the provision of clinical services. I.K. is jointly funded for a PhD by MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (LSHTM), UK and UK Medical Research Council (MRC).

The authors have no conflicts of interest to disclose.

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Received March 11, 2019

Accepted July 08, 2019

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