Toward achieving the 95-95-95 targets among key populations in Eswatini: results from an integrated bio-behavioral surveillance survey


BACKGROUND: In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the 95-95-95 targets to be achieved by 2030. We conducted an integrated-biobehavioral-surveillance-survey (IBBSS) in Eswatini among key populations (KPs) to quantify HIV prevalence, knowledge of HIV status, treatment uptake, and viral load (VL) knowledge and status.
METHODS: Between October 2020 and January 2021, FHI 360 LINKAGES project and Swaziland National AIDS Program conducted a cross-sectional-study among 416 men who have sex with men (MSM) and 676 female sex workers (FSWs) in Eswatini. Participants were recruited via respondent-driven sampling, a network-based peer-referral method designed for hard-to-reach populations. We included FSWs who reported majority of their income in the past 12 months was from sex-work and MSM who reported having had anal sex with another man in the past 12 months. All participants were '¥18year, able to provide informed consent, and willing to undergo HIV testing and viral load (VL) testing if identified HIV positive. Participants completed a survey. The study was approved by Eswatini and FHI 360 ethics committees.
RESULTS: Most KP individuals (99% FSWs, 98% MSM) were tested before. 60.7% FSWs tested HIV positive in the study and 86% already knew their status, while 27.1% MSM tested HIV positive and 58% already knew their status. Antiretroviral therapy (ART) uptake was higher among FSWs, 97.7% (345/353), than MSM, 93.9% (63/66), while treatment-adherence was 99.7% (344/345) among FSWs and 99% (62/63) among MSM. Though 86.9% of FSWs and 87% of MSM reported previous VL testing, knowledge of VL status was low, with 33.6% of FSWs and 3.7% of MSM aware. Only 2.6% of FSWs and 1.8% of MSM reported VL suppression. However, VL testing from the study was 75% suppression for MSM and FSW but only 2.2% were aware they were suppressed.
CONCLUSIONS: Eswatini's KPs have not yet reached all 95-95-95 (80%, 97%, 94%, respectively) targets. MSM were lower in all outcomes except ART adherence, indicating a need for programs to focus on MSM outcomes. Knowledge of VL status was very low and programs should look for innovative strategies to increase access to VL testing and improve KPs VL knowledge.