HIV pre-exposure prophylaxis adherence among female sex workers in Mutare urban, Zimbabwe
Abstract
Pre-exposure prophylaxis (PrEP) for HIV is a strategy that has been recently engineered to prevent individuals who are human immunodeficiency virus (HIV)-negative but are at high risk of being infected with HIV. Sex workers are one of the vulnerable groups that are targeted by PrEP, however effectiveness of PrEP is realised when there is maximum adherence. Empirical evidence from Mutare Urban district revealed that for the period April to November 2019, the adherence rate was 22 % (NAC, 2019).Therefore, this study sought to unearth the reasons why sex workers were not adhering to PrEP. A 1:1 unmatched case-control study was carried out in Mutare urban. The source population of this study was all female sex workers registered under NAC key population programs in two sites namely Forbes and Sakubva residing in Mutare urban. A total sample size of 64 participants calculated using Epi info 7 was used for this study. Participants were identified from records at the study sites and systematic sampling was done for both controls and cases. Proportional selection of participants was done for the two centres. Data was collected using an interviewer administered structured questionnaire and a key informant interview guide was used to interview health service providers. Data was analysed using Epi info version 7. A multivariate analysis showed age [AOR = 2.14, 95% CI (1.08 – 3.34)], household expenditure per month [AOR = 18.77, 95% CI (3.13 – 11.21)], consistent use of condoms [AOR = 11.78, 95% CI (1.03 – 13.41)], alcohol use [AOR = 2.55, 95% CI (1.01 –5.32)], experienced side effects [AOR = 16.06, 95% CI (5.71 – 22.56)] and satisfaction with health service provision [AOR = 10.01, 95% CI (2.32 – 43.25)] to be statistically significant predictors of uptake of PrEP services. There is need for tailor made interventions for young sex workers, furthermore use of mobile applications to remind clients, provision of safety nets and continued health education to both the female sex workers and the community at large to reduce stigmatization.
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References
UNAIDS, 2016
Donnell, D., Baeten, J. M., Bumpus, N. N., Brantley, J., Bangsberg, D. R., Haberer, J. E., Mujugira, A., Mugo, N., Ndase, P., Hendrix, C., & Celum, C. (2014). HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. Journal of acquired immune deficiency syndromes (1999), 66(3), 340–348.
Jessica, E.H., Jared, M.B., James, C., Wangisi, J.E., Katabira, A.R., Elioda, T., Christina, P., Stevn, A., Safren, N.C., Katherine, K.T., Deborah, D., Meighan, K., Lara, K., Connie, C., & David, R.B., (2013). Adherence to Antiretroviral Prophylaxis for HIV Prevention: A Sub study Cohort within a Clinical Trial of Serodiscordant Couples in East Africa, PLoS Med. 2013 Sep; 10(9.
National AIDS Council of Zimbabwe (2019).
Ojeda, V.D., Amico, K.R., Hughes. J.P., Wilson, E., Li, M., Holtz, T.H., Chitwarakorn, A., Grant, R.M., Dye, B.J., Bekker, L.G., Mannheimer, S., Marzinke, M., Hendrix, C.W., (2019). Low Disclosure of PrEP non adherence and HIV-Risk Behaviours Associated with Poor HIV PrEP Adherence in the HPTN 067/ADAPT Study, Journal Acquired Immune Deficiency Syndrome. 2019 Sep 1; 82(1):34-40
Footer, K.H.A., Lim, S., Rael, C.T., Greene, G.J., Carballa-Diéguez, A., Giguere, R., Martinez, M., Bockting, W., D'Aquila. R., Sherman, S.G., (2019). Exploring new and existing PrEP modalities among female sex workers and women who inject drugs in a U.S. city. AIDS Care. 2019 Oct; 31(10):1207-1213.
Zhejiang, D., Xue, B., Yi, Xue, B., (2011). Acceptability of pre-exposure prophylaxis among female sex workers in Xinjiang, 40(3):281-5,
Lankowski, A.J., Bien-Gund, C.H., Patel, V.V., Felsen. U.R., Silvera, R., Blackstock, O.J., (2019). PrEP in the Real World: Predictors of 6-Month Retention in a Diverse Urban Cohort. AIDS Behaviour. 2019 Jul;23(7):1797-1802.
Jerome, T., Galea, M.S.W., Janni, J.K., Ximena, S., Sung-Jae, L., Mazie, G., Jennifer, N., Sayles, M.D., Cáceres, C., & William, E., Cunningham, M.D., (2011). Acceptability of Pre-Exposure Prophylaxis (PrEP) as an HIV prevention strategy: Barriers and facilitators to PrEP uptake among at-risk Peruvian populations. International Journal STD AIDS. 2011 May; 22(5): 256–262
Fearon, E., Phillips, A., Mtetwa, S., Chabata, S. T., Mushati, P., Cambiano, V., Busza, J., Napierala, S., Hensen, B., Baral, S., Weir, S. S., Rice, B., Cowan, F. M., & Hargreaves, J. R. (2019). How Can Programs Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis. Journal of acquired immune deficiency syndromes (1999), 81(1), 24–35.
Liu, A. Y., Hessol, N. A., Vittinghoff, E., Amico, K. R., Kroboth, E., Fuchs, J., ... & Buchbinder, S. P. (2014). Medication adherence among men who have sex with men at risk for HIV infection in the United States: implications for pre-exposure prophylaxis implementation. AIDS patient care and STDs, 28(12), 622-627.
World Health Organization. (2002). Coverage of selected health services for HIV/AIDS prevention and care in less developed countries in 2001. In Coverage of selected health services for HIV/AIDS prevention and care in less developed countries in 2001.
Cowan, F.M., & Delany-Moretlwe, S., (2016). Promise and pitfalls of pre-exposure prophylaxis for female sex workers, Current Opinion in HIV and AIDS, 11(1), 27-34.
van der Elst, E.M., Mbogua, J., Operario, D., Mutua, G., Kuo, C., Mugo, P., & Sanders, E.J., (2013). High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: Qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya, AIDS and Behaviour, 17(6), 2162-2172.
Bazzi, A. R., Yotebieng, K., Otticha, S., Rota, G., Agot, K., Ohaga, S., & Syvertsen, J. L. (2019). PrEP and the syndetic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya. Journal of the International AIDS Society, 22(4), e25266.
Mutua, G., Sanders, E., Mugo, P., Anzala, O., Haberer, J. E., Bangsberg, D., ... & Fast, P. (2012). Safety and adherence to intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers. PloS one, 7(4).
Poon, A.N., Han, L., Li, Z., Zhou, C., Li, Y., Huang, L., Liao, M., Shepard, C., Bulterys, M., (2019). Acceptability and willingness of HIV pre-exposure prophylaxis amongst female sex workers in China, AIDS Care. 2019 Dec; 31(12):1555-1564.
Haire B. G. (2015). Pre-exposure prophylaxis-related stigma: strategies to improve uptake and adherence - a narrative review. HIV/AIDS (Auckland, N.Z.), 7, 241–249.
Galea, J. T., Kinsler, J. J., Salazar, X., Lee, S. J., Giron, M., Sayles, J. N., ... & Cunningham, W. E. (2011). Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. International journal of STD & AIDS, 22(5), 256-262.
Tangmunkongvorakul, A., Chariyalertsak, S., Amico, K. R., Saokhieo, P., Wannalak, V., Sangangamsakun, T., ... & Grant, R. (2013). Facilitators and barriers to medication adherence in an HIV prevention study among men who have sex with men in the iPrEx study in Chiang Mai, Thailand. AIDS care, 25(8), 961-967.
Van Damme, L., Corneli, A., Ahmed, K., Agot, K., Lombaard, J., Kapiga, S., ... & Temu, L. (2012). Preexposure prophylaxis for HIV infection among African women. New England Journal of Medicine, 367(5), 411-422.
Smith, D. K., Toledo, L., Smith, D. J., Adams, M. A., & Rothenberg, R. (2012). Attitudes and program preferences of African-American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Education and Prevention, 24(5), 408-421.
Qu, D., Zhong, X., Xiao, G., Dai, J., Liang, H., Huang, A., (2018). Adherence to pre-exposure prophylaxis among men who have sex with men: A prospective cohort study, International Journal Infectious Disease. 2018.
Pacífico de Carvalho, N., Mendicino. C.C.P., Cândido, R.C.F., Alecrim D.J.D., Menezes de Pádua, C.A., (2019). HIV pre-exposure prophylaxis (PrEP) awareness and acceptability among trans women: A Review. AIDS Care. 2019 Oct; 31(10):1234-1240.
Sidebottom, D., Ekström, A. M., & Strömdahl, S. (2018). A systematic review of adherence to oral pre-exposure prophylaxis for HIV - how can we improve uptake and adherence?. BMC infectious diseases, 18(1), 581. Retrieved from https://doi.org/10.1186/s12879-018-3463-4.
Ezennia, O., Geter A., & Smith, D.K., (2019). The PrEP Care Continuum and Black Men Who Have Sex with Men: A Scoping Review of Published Data on Awareness, Uptake, Adherence, and Retention in PrEP Care, AIDS Behaviour. 2019 Oct; 23(10):2654-2673.
Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana).
Zimbabwe National Statistics Agency (ZIMSTAT), (2012). Zimbabwe.
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