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

Authors

S Wilson Beckham, Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA s.wilson.beckham@jhu.edu.
Andrea Mantsios, Phia Consulting, New York, New York, USA.
Noya Galai, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Samuel Likindikoki, Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of.
Jessie Mbwambo, Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of.
Wendy Davis, Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Deanna Kerrigan, Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA.

Document Type

Journal Article

Publication Date

8-17-2022

Journal

BMJ open

Volume

12

Issue

8

DOI

10.1136/bmjopen-2021-058611

Keywords

HIV & AIDS; PREVENTIVE MEDICINE; PUBLIC HEALTH

Abstract

OBJECTIVES: Modalities 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. DESIGN: Sequential, explanatory, mixed methods. SETTING: Iringa, Tanzania. PARTICIPANTS: FSW 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). RESULTS: Participants 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). CONCLUSIONS: Offering 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 NUMBER: NCT02281578.

APA Citation

Beckham, S Wilson; Mantsios, Andrea; Galai, Noya; Likindikoki, Samuel; Mbwambo, Jessie; Davis, Wendy; and Kerrigan, Deanna, "Acceptability of multiple modalities of pre-exposure prophylaxis (PrEP) among female sex workers in Tanzania: a mixed-methods study" (2022). GW Authored Works. Paper 1469.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1469

Department

Prevention and Community Health