Unlocking insights into HIV care: An in-depth analysis of key populations from the Fast-Track Cities Quality of Care survey in eThekwini, KwaZulu-Natal, South Africa.

Background: Key populations experience disproportionate HIV burdens and structural barriers to care. Objective: To compare healthcare utilisation, HIV knowledge and barriers between key population groups (KPG) and non-key populations living with HIV in eThekwini, South Africa. Methods: We analysed the eThekwini Fast-Track Cities Quality of Care survey, a cross-sectional study across 30 high-HIV-burden facilities (April to July 2023). Adults living with HIV completed anonymous questionnaires; groups were compared using Results: Of 517 analysed participants, 128 (24.8%) were KPG. KPG participants were younger, more recently diagnosed (< 1 year: 9.4% vs 1.3%) and more often on antiretroviral therapy (ART) for 1-4 years (52.3% vs 33.4%), with similar daily adherence (~83%). KPG were more likely to access care via non-governmental organisations (NGOs; 23.4% vs 5.7%). Controls more often understood undetectable viral load (36.0% vs 21.9%) and that treatment benefits outweigh side effects (65.3% vs 42.9%). KPG more frequently reported undetectable viral load (55.5% vs 29.8%), more frequent screening for co-morbid conditions, and transport-cost barriers (15.6% vs 8.2%). In KPG, NGO care was associated with partner notification (adjusted odds ratio 18.06; 95% confidence interval 4.77-68.41). Conclusion: There are marked differences between KPG and adults with HIV in healthcare utilisation, HIV knowledge and structural barriers.