Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India

Abstract

We assessed the impact of pre-exposure prophylaxis (PrEP) in the context of a community-based HIV program among female sex workers (FSWs) in Kolkata, India. This was an open-label, uncontrolled demonstration trial. HIV seronegative FSWs over 18 years were eligible. Participants were administered daily tenofovir/emtricitabine (TDF-FTC) with follow-up visits at months 1, 3, 6, 9, 12, and 15. Drug adherence was monitored by self-report, and a random subset of participants underwent plasma TDF testing. 843 women were screened and 678 enrolled and started on PrEP. Seventy-nine women (11%) did not complete all scheduled visits: four women died of reasons unrelated to PrEP and 75 withdrew, for a 15-month retention rate of 89%. Self-reported daily adherence was over 70%. Among those tested for TDF, the percentage of women whose level reached ≥40 ng/mL was 65% by their final visit. There were no HIV seroconversions, and no evidence of significant changes in sexual behavior. This study demonstrated the feasibility and effectiveness of PrEP for FSWs in Kolkata, with very high levels of adherence to PrEP and no HIV seroconversions. The integration of PrEP into an existing community-based HIV prevention program ensured community support and facilitated adherence.

HIV pre-exposure prophylaxis uptake, retention and adherence among female sex workers in sub-Saharan Africa: a systematic review

“…Reasons for PrEP discontinuation included moving out of town, 7 25 returning to the country of origin, 27 pregnancy, 25 27 no longer doing sex work, 7 24 not taking a daily pill, 7 24 breast feeding, HIV seroconversion, desire to marry, partner’s request, 27 serious injury or death, 25 and being in police custody. 24 …”

“…Five studies reported PrEP adherence 24 25 27 28 32 ( online supplemental table 3 ), of which four studies reported facility models. 24 25 27 28 The most common adherence measure was self-report.…”

“…Five studies reported PrEP adherence 24 25 27 28 32 ( online supplemental table 3 ), of which four studies reported facility models. 24 25 27 28 The most common adherence measure was self-report. 24 27 28 32 Other adherence measures were plasma tenofovir disoproxil fumarate levels 24 25 32 and Medical Event Management System.…”

“… 24 25 27 28 The most common adherence measure was self-report. 24 27 28 32 Other adherence measures were plasma tenofovir disoproxil fumarate levels 24 25 32 and Medical Event Management System. 25 Adherence after 7 days was mostly self-reported and increased from 71% in the 1st month to 75% by the 15th month.…”

HIV Preexposure Prophylaxis With Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women

“…Data were analyzed from prospective studies involving oral F/TDF for PrEP in cisgender women and adolescents conducted between 2012, the year F/TDF for PrEP was approved for use in the US, and 2020. These studies were performed as part of the postmarketing commitment to the FDA and were either demonstration projects (n = 7) or open-label studies (n = 4), with 7 conducted in sub-Saharan Africa, 2 in India, and 2 in the US (Table). Study populations varied, but all included individuals who could benefit from PrEP and persons in serodiscordant (1 partner living with HIV and 1 partner without HIV) relationships, adolescent females and young women, and female sex workers.…”