Determinants of HIV Preexposure Prophylaxis Adherence Among Female Sex Workers in a Demonstration Study in Cotonou, Benin: A Study of Behavioral and Demographic Factors

Mboup, Aminata; Diabaté, Souleymane; Béhanzin, Luc; Zannou, Djimon Marcel; Kêkê, René K; Bachabi, Moussa; Gangbo, Flore; Marzinke, Mark A.; Hendrix, Craig W.; Gagnon, Marie‐Pierre; Alary, Michel

doi:10.1097/olq.0000000000001373

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…We also found that female sex workers aged between 18 and 25 years had an increased risk of early disengagement from PrEP services compared with those aged above 35. This finding corroborates earlier evidence that higher age predicts consistent PrEP use25 26 and is likely related to factors ranging from the individual to the structural level (neurocognitive development, peer influence, socioeconomic and structural vulnerabilities, etc) 58. Health services need to be particularly considerate when encountering young women who sell sex, ensuring that they experience friendly services and providers that are suitably trained on their needs.…”

Section: Discussionsupporting

confidence: 84%

“…The factors explored in this study are situated in different layers of the socioecological model, although several factors can be seen as belonging to more than one layer. At the individual level, studies have shown that older age at PrEP initiation can predict continuation among female sex workers,25 26 while high self-perceived HIV risk has been linked to PrEP uptake and continuation 27. Often referred to as psychosocial factors, poor mental health and alcohol use have been linked to adherence to or continuation with PrEP 25 26.…”

Section: Introductionmentioning

confidence: 99%

“…At the individual level, studies have shown that older age at PrEP initiation can predict continuation among female sex workers,25 26 while high self-perceived HIV risk has been linked to PrEP uptake and continuation 27. Often referred to as psychosocial factors, poor mental health and alcohol use have been linked to adherence to or continuation with PrEP 25 26. On the interpersonal/network level, we explore if sexual and/or prevention practices such as condom use and number of sex work clients are factors that influence disengagement with PrEP services.…”

Section: Introductionmentioning

confidence: 99%

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Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach

Lichtwarck,

Mbotwa,

Kazaura

et al. 2023

BMJ Glob Health

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IntroductionPre-exposure prophylaxis (PrEP) is an effective HIV prevention tool when taken as prescribed. However, suboptimal use may challenge its real-life impact. To support female sex workers in their efforts to prevent themselves from HIV, it is essential to identify factors that contribute to early disengagement from PrEP care. In this study, we aimed to estimate the risk of early disengagement from PrEP services among female sex workers in Tanzania and associated factors using a socioecological model as a guiding framework.MethodsThe study was conducted as part of a pragmatic mHealth trial for PrEP roll-out in Dar es Salaam in 2021. We estimated the risk of early disengagement, defined as not presenting for the first follow-up visit (within 56 days of enrolment), and its associations with individual, social, behavioural and structural factors (age, self-perceived HIV risk, mental distress, harmful alcohol use, condom use, number of sex work clients, female sex worker stigma and mobility) using multivariable logistic regression models, with marginal standardisation to obtain adjusted relative risks (aRR).ResultsOf the 470 female sex workers enrolled in the study, 340 (74.6%) did not attend the first follow-up visit (disengaged). Mental distress (aRR=1.14; 95% CI 1.01 to 1.27) was associated with increased risk of disengagement. Participants who reported a higher number of clients per month (10–29 partners: aRR=0.87; 95% CI 0.76 to 0.98 and ≥30 partners: aRR=0.80; 95% CI 0.68 to 0.91) and older participants (≥35 years) (RR=0.75; 95% CI 0.56 to 0.95) had a lower risk of disengagement.Conclusions and recommendationsEarly disengagement with the PrEP programme was high. Mental distress, younger age and having fewer clients were risk factors for disengagement. We argue that PrEP programmes could benefit from including mental health screening and treatment, as well as directing attention to younger sex workers and those reporting fewer clients.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach

Lichtwarck,

Mbotwa,

Kazaura

et al. 2023

BMJ Glob Health

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“…Previous studies of FSW in most countries point to chronic unstable housing and financial insecurity, which may lead to challenges in sustained PrEP adherence. [24][25][26] Lastly, it is important to acknowledge the importance of social status, power, control, and education in the demand for PrEP. Compared to FSW in Britain, health issues are perceived as less important and FSW face fewer challenges with safe work spaces, violence, and control over interactions with clients.…”

Section: Discussionmentioning

confidence: 99%

Exploring Attitudes Toward Pre-Exposure Prophylaxis for HIV Prevention Prior to Implementation Among Female Sex Workers in Malaysia: Results from a Qualitative Study

Foley,

Keene,

Shrestha

et al. 2024

PPA

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Introduction Pre-exposure prophylaxis (PrEP) is an effective method for prevention of HIV transmission. Female sex workers (FSW) in Malaysia are at substantially increased risk of acquiring HIV compared to the general female population, yet little is known about this population’s current HIV prevention practices or acceptance of PrEP. This study aims to inform the culturally relevant implementation of PrEP through the qualitative exploration of (1) the potential need for PrEP in this population and (2) the factors that determine FSW willingness to use oral PrEP. Methods In-depth, semi-structured interviews (n = 30) were conducted with FSW in English, Malay, or Tamil. Transcribed and translated interviews were analyzed using a grounded theory approach. Results FSW express positive interest in PrEP but prefer it as a supplement to condoms, not a replacement. Perceived challenges to PrEP use include cost, adherence, and side effects. Conclusion The findings suggest that in combination with condom use, PrEP may be an acceptable method of HIV prevention. Effective PrEP rollout may also include condom promotion using a peer-driven model, cost subsidies, and sex work harm reduction and empowerment components.

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“…[13] However, despite the high risk of HIV acquisition among FSWs, most studies on PrEP adherence among FSWs have revealed minimal compliance with the provided prophylaxis. [14][15][16][17] Literature on adherence to HIV oral PrEP is limited. This study aims to determine adherence and factors associated with non-adherence to oral HIV PrEP by gathering information related to the extent to which FSWs receive the PrEP service in the Mara region.…”

Section: The Authors Have No Conflicts Of Interest To Disclosementioning

confidence: 99%

Factors associated with adherence to oral HIV pre-exposure prophylaxis among female sex workers in the Mara Region, Tanzania: A 2022 cross-sectional study

Churu,

Kulemba,

Kapesa

et al. 2023

Medicine

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Female sex workers (FSWs) have a higher risk of acquiring human immunodeficiency virus (HIV) infection compared with the general female population. Tanzania adopted pre-exposure prophylaxis (PrEP) use for HIV-negative key populations in 2019 as a strategy to reduce HIV transmission. We aimed to identify factors associated with PrEP adherence among FSWs in Tanzania. We conducted a cross-sectional study of FSWs using oral HIV PrEP from June-July 2022 in 5 Mara Region districts. Stata software was used to analyze the quantitative data. Poor overall PrEP adherence was observed among FSWs, with adherence of 48.3% (174/360) and 43.3% (156/360) according to pill count and self-reports, respectively. Participants living with family members had 2.32 higher odds of PrEP adherence (adjusted odds ratio [aOR] = 2.32, 95% confidence interval [CI] = 1.27–42.23, P = .006) versus participants living alone or with friends. Moreover, FSWs who preferred pill packages had 1.41 higher odds of adherence (aOR = 2.43, [95% CI = 1.41–4.19, P = .001]); participants with a good perception of PrEP had 1.71 higher odds (aOR = 1.71, [95% CI = 1.01–2.91, P = .047]) of PrEP adherence. We found that living with family, pill packaging, and PrEP perception played significant roles in PrEP adherence among FSWs. Interventions to improve pill packaging, social support, and the perception of PrEP among FSWs should be intensified to increase adherence in this vulnerable population.

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Determinants of HIV Preexposure Prophylaxis Adherence Among Female Sex Workers in a Demonstration Study in Cotonou, Benin: A Study of Behavioral and Demographic Factors

Abstract: A study of demographic and behavioral factors found that older age, high intention, and shorter duration of preexposure prophylaxis use were associated with higher preexposure prophylaxis adherence among Beninese female sex workers.

Cited by 6 publications

References 29 publications

Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach

Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach

Exploring Attitudes Toward Pre-Exposure Prophylaxis for HIV Prevention Prior to Implementation Among Female Sex Workers in Malaysia: Results from a Qualitative Study

Factors associated with adherence to oral HIV pre-exposure prophylaxis among female sex workers in the Mara Region, Tanzania: A 2022 cross-sectional study

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