Retention of Female Sex Workers at one month taking oral Pre-exposure prophylaxis for HIV prevention in selected Public Health facilities in Kampala, Uganda

Abstract

ABSTRACTRationaleRetention of Female sex workers at one month of PrEP is critical as low retention may lead to sub-optimal protection and increased HIV incidence rates in this sub-population. We determined factors associated with retention at one month among Female Sex workers on Pre-Exposure Prophylaxis for HIV prevention in selected health facilities in Kampala Capital City Authority, Uganda.MethodsIn this retrospective cohort study we followed 350 FSWs from September to December 2021; and 30 women underwent in-depth interviews. Retention was categorically defined as the number of FSWs who adhered to their clinic appointments got refills over the total number of FSWs expected to come for a refill. Poisson regression was used for multivariate analysis and thematic data analysis was conducted for the quantitative and qualitative data respectively.ResultsThe median age of the FSWs was 25 years. 40.9% of the FSWs had attended primary level, 43.7% secondary level, 3.4% tertiary level education respectively, and 12% had no education. The mean duration of sex work was 3 years.On average, the FSWs had 14 sex partners in the past week. 59.4% reported lubricant use on the last sexual encounter compared to 40.6% who did not use lubricants. Factors associated with retention to PrEP at bivariate level were religion, place of work, lubricant use, use of drugs, received PrEP counselling at initiation, the color of PrEP tablet, pill size and attitude of health care workers. The Poisson regression showed that Retention to PrEP was 7% higher among sex workers that use lubricants compared to those that don’t use holding other factors constant (adjusted 0.02 [1.01, 1.14] IRR 1.07) and retention to PrEP among sex workers that think the health care workers had a good attitude was 23% higher than those that think HCW had fair attitude holding other factors constant (adjusted 0.012 [1.05, 1.44] IRR 1.23). FSWs who had no stigma had 90% higher retention than those who had stigma) (adjusted 0.04 [0.814, 0.996] IRR 0.90).No drugs at the facility affected PrEP retention by about 76% among FSWs (adjusted 0.003 [0.67, 0.922] IRR 0.76). FSWs were retained to PrEP because they felt at risk when they experienced condom breaks during intercourse or they failed to use condoms with a client. Barriers to PrEP retention included drug side effects, lack of financial resources, food insecurity, stigma, and doubts about PrEP efficacy, travel and health system factors.ConclusionA high proportion of FSWs were retained on PrEP. FSWs considered PrEP as a reliable method of protection against HIV in cases of condom breaks or if they had sex without a condom. A number of barriers to PrEP retention at both personal and systems-level need to be addressed for successful PrEP implementation.