Abstract
In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. Studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical among FSWs to maximize HIV prevention. However, implementation data on adherence to PrEP among FSWs is limited so this study sought to assess adherence to PrEP. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, and 2) determine factors associated with PrEP adherence. This cross-sectional study was conducted from November to December 2018; 126 FSWs using PrEP were interviewed using a questionnaire. Adherence was categorically defined as high adherence and low adherence. Logistic regression was done. Using long-term contraception methods (OR 0.06, 95% CI: 0.04-0.77) and not using condoms with clients (OR 0.07, 95% CI: 0.01-0.42) were negatively associated with high PrEP adherence. Barriers to PrEP adherence need to be addressed for successful PrEP implementation to improve adherence going forward. Service care providers should reinforce positive behaviors such as use of condoms devotedly during PrEP breaks.
Highlights
In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%)
pre-exposure prophylaxis (PrEP) adherence has been studied in the context of clinical trials, for other at-risk populations such as sero-discordant couples and among men who have sex with men (MSM), but little is known about factors associatedwith adherence in real world settings, for FSWs
The site offers PrEP to FSWs and other key populations: Most at Risk Populations Initiative (MARPI) is a Centers for Disease Control and Prevention (CDC) funded programme that was started in 2008 to deal with health issues affecting key populations, including FSWs that are at a high risk of contracting the HIV virus11
Summary
In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. PrEP adherence has been studied in the context of clinical trials, for other at-risk populations such as sero-discordant couples and among men who have sex with men (MSM), but little is known about factors associatedwith adherence in real world settings, for FSWs. In Uganda PrEP roll-out started in August 2017 in a phased way, initially offered at public health facilities that provide care to high risk populations. Studies further report drug-related issues, such as side-effects and pill characteristics; logistical issues around drug use, such as timely refills and travel; and social stigma as barriers to PrEP use among potential PrEP users12,13 These studies have been conducted in different settings, and such factors have not been studied in Uganda among people using PrEP after PrEP roll-out
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