Health Systems and Public Health

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Browsing Health Systems and Public Health by browse.metadata.advisor "Cois, Annibale"

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    Acceptability and accessibility of pre-exposure prophylaxis modalities for HIV prevention (oral daily PrEP, dapivirine vaginal ring and long-acting cabotegravir injectable) among female sex workers in Salt River, Cape Town : a cross-sectional study
    (Stellenbosch : Stellenbosch University, 2022-12) Mbuyamba, Rachel; Cois, Annibale; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Background: Female sex workers (FSWs) are at high risk of contracting HIV and have poor access to health care. Evidence is being collected in real world settings on the acceptability and accessibility of pre-exposure prophylaxis (PrEP) amongst FSWs. We explored oral PrEP accessibility, associated factors and acceptability of alternative PrEP modalities. Methods: This cross-sectional study involved 100 HIV-negative FSWs aged >18 years receiving services at the Wits RHI Sex Worker Clinic in Salt River. We tested the association between oral PrEP uptake status and independent variables using logistic regression models. Poisson regression models were used to identify factors associated with oral PrEP accessibility levels. Linear regression was used to identify factors associated with acceptability of alternative PrEP modalities. Results: FSWs with median age 32.6 years (interquartile range 11.7 years) participated in this study, with 97% indicating that they were at risk for HIV infection. Oral PrEP uptake was 33%. Condom use with the main partner (OR = 0.2, 95% CI: 0.0-0.9, sometimes vs. never) was negatively associated with oral PrEP uptake and no previous experience with long-acting drugs (OR = 5.4, 95% CI: 2.2-13.4) was positively associated with oral PrEP uptake. Accessibility of oral PrEP was lower among FSWs for whom sex work was their secondary source of income compared to those for whom sex work was a primary source of income (aIRR for accessibility score = 0.8, 95% CI: 0.7 – 0.9). Acceptability of alternative PrEP modalities was lower among FSWs with previous treatment for sexually transmitted diseases (differences in acceptability scores -5.1, 95% CI: -14.9– 4.6). Long waiting times (72% of participants), PrEP unavailability (27%), PrEP side effects (38%), limited privacy (31%) and nurse unavailability were the main barriers to PrEP uptake. The perceived risk of HIV infection, and the availability (43%) and cost (71%) of PrEP uptake were PrEP uptake facilitators. Conclusions: Oral PrEP uptake among FSWs is currently low. Limited privacy and side effects were the main barriers to PrEP uptake. FSWs were willing to use the new PrEP modalities when available. This study provides valuable lessons for a successful introduction of new PrEP modalities.