Background: As countries scale up anti-retroviral treatment (ART) to achieve epidemic control and end the global HIV pandemic by 2030, it is critical to understand factors associated with ART uptake to guide program modification and implementation. Data from the Swaziland HIV Incidence Measurement 2 (SHIMS2) included measurement of progress towards the UNAIDS three 90s i.e. HIV status awareness, ART uptake and viral load suppression. Although Swaziland has made significant progress, deeper analysis is required to understand which populations and geographic locations are not meeting ART coverage targets.
Methods: Using data from a nationally representative survey, we examined correlates of ART uptake, defined as either self-reporting being on ART and/or testing positive for one or more antiretrovirals in their blood. The survey used a two-stage cluster sampling design to attain a nationally representative sample. National testing algorithm was used to determine HIV status and a qualitative assay to test for efavirenz, nevirapine, and lopinavir. Prevalence and correlates of ART use were estimated using weighted multivariable logistic regression analyses with jackknife variance estimation methods accounting for the complex survey design.
Results: Of the 2,997 HIV+ participants, 87.0% were reported to be aware of their status with 88.8 % of those being on ART. ART uptake did not differ by sex. Compared to people residing in Lubombo (Eastern region), people residing in Hhohho (Adjusted odds ratio [aOR]: 1.83, p=0.0127) and Shiselweni (aOR: 1.92, p=0.0105) regions had higher odds of ART uptake. Those with lower than secondary education had higher odds of being on ART compared to those with secondary education or higher (aOR: 0.65, p=0.0096). Older participants ( 35-44 years, aOR: 1.70, p=0.0390; 45+ years, aOR: 1.81, p=0.0480) were more likely to be on ART compared to 15-24 year olds while those that had disclosed their HIV status were 92% more likely to be on ART compared to those who had to hide their status (aOR: 1.92, p=0.0034).
Conclusions: Disparities observed in ART uptake by region, level of education, age and disclosure status, emphasize the need to expand and modify existing interventions to reach specific sub-populations that currently have lower ART coverage as demonstrated in this analysis.

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