Uptake, retention, and outcomes in a demonstration project of pre-exposure prophylaxis among female sex workers in public health centers in Senegal

Abstract

The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk perception. There were no new HIV infections at follow-up. Our results showed evidence of high interest in PrEP and very good PrEP retention rates among FSWs at 12-month follow-up when offered in MoH-run clinics, with older age as the only significant predictor of higher PrEP retention. This highlights the role that these clinics can play in expanding PrEP access nationwide.

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

“…Smaller studies (TDF2-Botswana 9 and Bangkok-TDF 29 ) with better adherence (>75%) did show substantial effectiveness (RR 0.35, 95%CI 0.22-0.54), 21 and a recent demonstration trial 15) 0 (0) 0 0 14 (19) Not interested 0 (0) 1 ( 12) 4 ( 14) 6 ( 22) 0 (0) 0 0 11 (15) Other illness 0 (0) 0 (0) 2 ( 7) 1 ( 4) 1 (33) 0 0 4 (5) Daily PrEP inconvenient 1 ( 14) 1 ( 12) 2 ( 7) 0 (0) 0 (0) 0 0 4 (5) Partner not Supportive 0 (0) 1 ( 12) 1 ( 3) 2 ( 7) 0 (0) 0 0 4 (5) In police custody 0 (0) 0 (0) 0 (0) 1 ( 4) 1 (33) 0 0 2 (3) Embarrassed 0 (0) 0 (0) 2 ( 7) 0 (0) 0 (0 2) 32 ( 5) 43 ( 7) 25 ( 4) 23 ( 4) 39 ( 7) Took 1 pill every day last month, n (%) 320 ( 59) 289 ( 45) 269 ( 43) 249 ( 42) 145 ( 24) N/A Missed ≥ 7 days since last visit, n (%) 63 ( 12) 116 ( 18) 123 ( 20) 118 ( 20) 119 ( 20) 129 ( 22) Longest stretch (days) of nonadherence, median (Q1-Q3) from Senegal demonstrated high levels of retention and no incident HIV infections. 30 In our trial, most tested women had TDF levels suggestive of consistent TDF-FTC use, particularly among those tested in later visits. Importantly, there were no HIV seroconversions detected.…”

“…Smaller studies (TDF2-Botswana 9 and Bangkok-TDF 29 ) with better adherence (>75%) did show substantial effectiveness (RR 0.35, 95%CI 0.22–0.54), 21 and a recent demonstration trial from Senegal demonstrated high levels of retention and no incident HIV infections. 30 In our trial, most tested women had TDF levels suggestive of consistent TDF-FTC use, particularly among those tested in later visits. Importantly, there were no HIV seroconversions detected.…”

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

“… 12 In Senegal, adherence measured by MEMS (was initially 80% but dropped rapidly to 50% in the first 2 months). 13 Moreover, both these studies did not evaluate factors associated with adherence.…”

A community-based healthcare package combining testing and prevention tools, including pre-exposure prophylaxis (PrEP), immediate HIV treatment, management of hepatitis B virus, and sexual and reproductive health (SRH), targeting female sex workers (FSWs) in Côte d’Ivoire: the ANRS 12381 PRINCESSE project

“…The daily uptake of PrEP is not always adapted to FSWs’ life context. More broadly, the mobility of FSWs and the stigmatization they face from their neighborhood or healthcare professionals complicate their access to care and their retention in demonstration projects [ 20 , 21 , 46 , 47 ]. Beyond the development of community support and mobile clinics to limit these difficulties, exploring the suitability of long-acting PrEP to this population could be useful [ 48 ].…”