Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa.

Robyn Eakle,Adam Bourne,Judie Mbogua,Helen Rees,Nyaradzo Mutanha

doi:10.1002/jia2.25081

Abstract

IntroductionFemale sex workers (FSWs) are at high‐risk for HIV acquisition in South Africa, where the advent of new HIV prevention and treatment interventions represent the potential to significantly impact the epidemic. This paper focuses on aspects of PrEP acceptability as a new intervention within the context of a larger service delivery programme including the simultaneous rollout of early ART. This paper explores PrEP acceptability among the FGD participants as future potential users.Methods FGDs were conducted in two clinic‐based sites in Johannesburg and Pretoria. They aimed to explore community‐level, multi‐dimensional acceptability of PrEP within the context of imminent implementation alongside early ART in the TAPS Demonstration Project. Sex worker peer educators recruited participants from varying sex work locales. Facilitation was in English with adaptation by facilitators into local languages as needed. Transcripts were translated and transcribed into English. Thematic analysis was used to analyse the data.ResultsFour FGDs were conducted in each site for a total of eight FDGs and 69 participants. Demographics were largely similar across the sites. Overall, there was strong acceptability of PrEP among participants and positive anticipation for the imminent delivery of PrEP in the local sex worker clinics. Themes arising from the discussions exploring aspects of PrEP acceptability included: awareness and understanding of PrEP; PrEP motivations including choice, control, and vulnerability, managing PrEP risks and worries; and, de‐stigmatizing and empowering PrEP delivery. Participant discussions and recommendations highlighted the importance of developing clear education and messaging to accurately convey the concept of PrEP, and intervention integration into supportive and tailored services.ConclusionsThrough the course of these FGDs, PrEP became a positive and highly anticipated prevention option among the FSWs participants who endorsed implementation in their communities. Effective integration of PrEP into existing services will include comprehensive health programming where ART is also available, appropriate messaging, and support.

Highlights

Female sex workers (FSWs) are at high-risk for HIV acquisition in South Africa, where the advent of new HIV prevention and treatment interventions represent the potential to significantly impact the epidemic
Female sex workers (FSWs) are at high-risk for HIV acquisition in South Africa, with a recent study reporting a prevalence of 72% in the greater Johannesburg area, and 40% and 54% in Cape Town and Durban respectively [1]
We present findings from focus group discussions (FGDs) that sought to inform the design of oral pre-exposure prophylaxis (PrEP) and early ART interventions for FSWs in Johannesburg and Pretoria for implementation in the Treatment And Prevention for Sex workers (TAPS) Demonstration Project [25]

Summary

Introduction

Female sex workers (FSWs) are at high-risk for HIV acquisition in South Africa, where the advent of new HIV prevention and treatment interventions represent the potential to significantly impact the epidemic. The advent through clinical trials of oral pre-exposure prophylaxis (PrEP) for HIV prevention [2], and test and treat ( “early ART”) for HIV treatment [3,4], represent the potential to significantly impact the epidemic As a result, these two interventions have become part of the standard of care set out by the World Health Organization (WHO) in 2015 [5]. We are holding a few discussions with up to 10 women at a time to talk about experiences with health care in general and HIV testing, prevention and care services These discussions will help us understand whether we can put together a set of services tailored especially for female sex workers that will support their needs. We would like to find out what you think about current services, what is missing from them, what kinds of services you wish were available, difficulties in accessing testing and care, and your thoughts about new potential services

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