Abstract Body

Background:

Antiretroviral treatment (ART) sharing has been reported among fisherfolk and sex workers in Uganda and South Africa. However, to date, no population-based studies have documented the prevalence of ART diversion (including sharing [giving or receiving], buying, and selling ART pills) among men and women living with HIV in Africa, or its relationship with HIV viremia in these groups.

Methods:

From 2018-2020, we surveyed all people living with HIV aged 15-49 in 40 communities in the Rakai Community Cohort Study (RCCS), a population-based cohort in south-central Uganda. We assessed prevalence and correlates of self-reported ever and past-year ART diversion. We stratified data by age and gender, and documented diversion partners. We used log-binomial regression to assess the relationship between diversion patterns and viremia (viral load >1000 copies/ml), reported as risk ratios (RR) with 95% confidence intervals (CI).

Results:

Of 2,852 people living with HIV, 266 (9.3%) reported ART diversion. Giving and receiving were most common: 62 (2.2%) reported giving only, 54 (1.9%) reported receiving only, and 132 (4.6%) reported both giving and receiving. Few participants reported buying (n=18, 0.6%) and none reported selling. Men were more likely to report any diversion than women (12.9% vs. 7.4%), with men aged 25-34 reporting particularly high levels of sharing (18.9%) (Figure). Friends were the most common sharing partners, followed by spouses/sexual partners. Patterns of ever and past-year diversion were similar for age and gender. Among participants with viral load results, 8.6% (234/2,725) were viremic. People who reported only giving ART to others were twice as likely to be viremic than those who reported no diversion (RR:2.04, 95% CI:1.14-3.63), while those who reported only receiving ART had a non-significant lower prevalence of viremia (RR:0.48, 95% CI:0.12-1.89). Reporting both giving and receiving was not associated with viremia (RR:0.90, 95% CI 0.49-1.66).

Conclusions:

This first population-based assessment of ART diversion found that ART sharing is fairly common in rural Uganda, particularly among men. While receiving pills may support viral suppression, giving pills is associated with viremia. HIV programs may benefit from considering drug sharing in counseling messaging. Future longitudinal studies are needed to assess temporal relationships.

Prevalence of ART giving, receiving, buying, and selling by age category and gender among people living with HIV ages 15-49 in 40 study communities in south-central Uganda