Awareness of and willingness to use oral pre-exposure prophylaxis (PrEP) for HIV prevention among sexually active adults in Malawi: results from the 2020 Malawi population-based HIV impact assessment

Kabaghe, Alinune Nathanael; Singano, Victor; Payne, Danielle; Maida, Alice; Nyirenda, Rose; Mirkovic, Kelsey; Jahn, Andreas; Patel, Pragna; Brown, Kristin; Farahani, Mansoor; Kayigamba, Felix; Tenthani, Lyson; Ogollah, Francis; Auld, Andrew; Zulu, Fatima; Msungama, Wezi; Wadonda-Kabondo, Nellie

doi:10.1186/s12879-023-08683-1

Cited by 3 publications

References 21 publications

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High retention among key populations initiated on HIV pre‐exposure prophylaxis in Kigali City, Rwanda

Munyaneza,

Bhutada,

Shi

et al. 2024

J Int AIDS Soc.

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IntroductionKey populations (KPs) including female sex workers (FSWs) and men who have sex with men (MSM) in sub‐Saharan Africa are disproportionately impacted by HIV. Despite the increasing availability of pre‐exposure prophylaxis (PrEP), data on retention remain limited. This study assessed PrEP retention at 1 and 12 months among Rwandan FSWs and MSM.MethodsWe analysed routine clinical data on adult FSWs and MSM receiving PrEP care from 11 health facilities in Kigali, Rwanda between 2019 and 2022. Retention was defined as attendance at regularly scheduled appointments for a PrEP refill. We used logistic regression to assess associations between demographic and clinical characteristics and retention at 1 and 12 months.ResultsAmong 2043 PrEP initiators, 1343 (66%) were FSWs and 700 (34%) were MSM. FSWs reported a median number of eight sexual partners in the prior 7 days, 70% reported condomless sex and 94% considered themselves at high HIV risk. About 1239 (92%) and 1032 (77%) were retained at 1 and 12 months, respectively. One‐month retention was lower among FSWs living with others (OR 0.59, 95% CI: 0.35−0.99; ref: living alone) or with low HIV risk perception (OR 0.12, 95% CI: 0.04−0.29). At 12 months, low HIV risk perception remained statistically significant (aOR 0.20, 95% CI: 0.12−0.32). At PrEP initiation, MSM reported a median of four sexual partners in the prior 12 months, 88% reported condomless sex and 72% considered themselves at high HIV risk. Retention rates were 96% at 1 month and 82% at 12 months. At 1 month, retention was higher among MSM with some education (OR 12.74, 95% CI: 2.74−70.93; ref: no education). At 12 months, retention was lower among MSM with part‐time employment (aOR 0.29, 95% CI: 0.11, 0.76), students (aOR 0.12, 95% CI: 0.04, 0.37) and unemployed (aOR 0.12, 95% CI: 0.05, 0.28); ref: full‐employed) and those unaware of PrEP at baseline (aOR 0.15, 95% CI: 0.10, 0.23).ConclusionsWe observed very high rates of PrEP retention among Rwandan FSWs and MSM. Predictors of retention included living situation, employment status, HIV risk perception and low PrEP awareness, but differed between FSWs and MSM. These findings suggest that targeted awareness campaigns tailored to different KPs could improve PrEP retention in care.

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High retention among key populations initiated on HIV pre‐exposure prophylaxis in Kigali City, Rwanda

Munyaneza,

Bhutada,

Shi

et al. 2024

J Int AIDS Soc.

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Interest in Oral Pre-exposure Prophylaxis Among Men Who Have Sex with Men and Transfeminine Persons in HPTN 075, a Multi-center HIV Prevention Study in Sub-Saharan Africa (2015–2017)

Orinda,

Mudhune,

Opollo

et al. 2024

AIDS Behav

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Assessment of Awareness and Willingness to Use Pre-Exposure Prophylaxis for HIV Prevention among Female Sex Workers in Rwanda

Nzungize,

Munyaneza

2024

Preprint

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Background Female sex workers (FSWs) in sub Saharan Africa bear a disproportionate burden of HIV infection. While pre exposure prophylaxis (PrEP) is increasingly accessible in the region, limited data exist on FSWs awareness of and willingness to use PrEP. This study aimed to assess PrEP awareness and willingness to use it, along with associated factors, among FSWs in Kigali, Rwanda. Methods This cross sectional study, conducted from April to September 2024, evaluated PrEP awareness and willingness to use it among 333 FSWs recruited through community based FSW associations. Data were analyzed using SPSS, with logistic regression employed to explore associations between participant characteristics and PrEP awareness and willingness. Ethical approval was obtained from the Rwanda National Ethics Committee. Results The mean age of participants was 30 years (SD: 7.26), with 47% aged between 25 and 34. Most were single (67%) and unemployed (66%), with nearly half (49.5%) reporting only primary education. A significant proportion (81%) had undergone HIV testing in the past six months, and 50% had been involved in sex work for 2 to 5 years. The median number of sexual partners in the past week was 7. Awareness of PrEP was high (81%), however, consistent condom users were less likely to be aware of PrEP (adjusted odds ratio (aOR): 0.40, 95% confidence interval (CI): 0.19, 0.83), as were those not screened for sexually transmitted infections (STIs) compared to those who were screened (aOR: 0.43, 95% CI: 0.22, 0.85). Willingness to use PrEP was reported by 80% of participants. Those with a primary education were more willing to use PrEP compared to those with no formal education (aOR: 4.09, 95% CI: 1.62, 10.33). Conversely, participants screened for STIs were less likely to report willingness compared to those not screened (aOR: 0.28, 95% CI: 0.12, 0.62). Conclusion This study demonstrates high awareness and willingness to use PrEP among FSWs in Kigali. However, consistent condom users and those unscreened for STIs were less aware of PrEP, and willingness to use it varied based on education and STI screening status. These findings underscore the need for targeted health education and STI screening initiatives to enhance PrEP uptake and strengthen HIV prevention efforts in this vulnerable population.

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Awareness of and willingness to use oral pre-exposure prophylaxis (PrEP) for HIV prevention among sexually active adults in Malawi: results from the 2020 Malawi population-based HIV impact assessment

Cited by 3 publications

References 21 publications

High retention among key populations initiated on HIV pre‐exposure prophylaxis in Kigali City, Rwanda

High retention among key populations initiated on HIV pre‐exposure prophylaxis in Kigali City, Rwanda

Interest in Oral Pre-exposure Prophylaxis Among Men Who Have Sex with Men and Transfeminine Persons in HPTN 075, a Multi-center HIV Prevention Study in Sub-Saharan Africa (2015–2017)

Assessment of Awareness and Willingness to Use Pre-Exposure Prophylaxis for HIV Prevention among Female Sex Workers in Rwanda

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