Acceptability of multiple modalities of pre-exposure prophylaxis (PrEP) among female sex workers in Tanzania: a mixed-methods study

Abstract

ObjectivesModalities of pre-exposure prophylaxis (PrEP) for HIV prevention offer options to women at high risk including female sex workers (FSW). This study aimed to explore FSW’s acceptability and preferences for oral pills, long-acting (LA) injectable and vaginal ring PrEP.DesignSequential, explanatory, mixed methods.SettingIringa, Tanzania.ParticipantsFSW aged above 18 were recruited from sex work venues using time-location sampling (n=496); HIV-uninfected (n=293) were included in this analysis. Subsequently, survey participants were recruited for in-depth interviews (n=10) and two focus group discussions (n=20).Primary outcome measures(1) Acceptability of PrEP (Do you personally think it would be worth it to you to take ART if it could prevent HIV?: yes/no) and (2) preference for LA injectable versus oral pills (If you personally were going to take ART to prevent HIV infection, would you prefer to take it in the form of a daily pill or an injection once every 3 months? Injection/pill).ResultsParticipants were (92%) unaware of PrEP but 58% thought it would be worth it to personally take PrEP. Acceptability of PrEP was significantly associated with higher social cohesion (aOR 2.12; 95% CI 1.29 to 3.50) and STI symptoms in the past 6 months (aOR 2.52; 95% CI 1.38 to 4.62). Most (88%) preferred LA vs oral PrEP. Qualitative findings revealed generally positive reactions to all types of PrEP, and they were viewed as a welcome backup to condoms. Participants had concerns about pills (burden of daily use, stigma from clients), and the vaginal ring (fear of client noticing and becoming suspicious, fear of infertility) and overall preferred LA-PrEP (less frequent use, easy to hide, belief in higher efficacy).ConclusionsOffering multiple formulations of PrEP within the context of community-driven HIV prevention interventions among FSW may facilitate increased uptake and adherence. LA injectable PrEP may be a particularly preferred formulation among FSW.Trial registration numberNCT02281578.

Exploring Attitudes Toward Pre-Exposure Prophylaxis for HIV Prevention Prior to Implementation Among Female Sex Workers in Malaysia: Results from a Qualitative Study

“…The integration of condoms into their primary negotiations with clients and their prioritizing the use of condoms in secondary negotiations reflects effective and proactive efforts to reduce risk. These findings are similar to studies of FSW in Tanzania 22 and elsewhere. 8 Screening clients based on appearance and determining whether or not to use condoms based on familiarity may be less effective.…”

Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach

“…Another explanation could be fear of losing clients and thus income due to PrEP use among those with fewer paying partners, as they might be more dependent on the earning from each single client. Indeed, in a study from Tanzania before PrEP was available, female sex workers expressed concerns about stigma from clients as PrEP could be mistaken for ARVs and thus indicate HIV positive status 57. Work striving to limit public stigma related to both HIV and PrEP use continues to be particularly important.…”

User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

“…Many FSWs stated that protection by PrEP could enable them to have sex with clients without requiring condoms [20] or to accept condomless sex at a higher price [27], highlighting a potential concern regarding risk compensation. However, others viewed PrEP as a protective complement to condoms and stated that they would continue to use them to prevent STIs and pregnancy [26]. 86% of FSWs responded that they would likely use an implant in a South African DCE [21].…”