Uptake, Adherence and Retention of Daily Oral Pre-Exposure Prophylaxis among Female Sex Workers in the Greater Gaborone City, Botswana
International STD Research & Reviews, Volume 12, Issue 1,
Introduction: Female sex workers are estimated to be 30 times more likely to be living with Human Immuno-deficiency Virus than other women of reproductive age and face an increased burden of sexually transmitted infections. Pre-Exposure Prophylaxis was introduced in Botswana in 2018 as an addition to combination-prevention strategies. Since then, no study was carried out to assess the efficiency of PrEP as an intervention. This study aimed to assess the uptake, adherence and retention of daily oral Pre-Exposure Prophylaxis among female sex workers in the Greater Gaborone City, Botswana.
Methods: Retrospective, quantitative cross-sectional study was carried out Between August 2018 and May 2020. Purposive sampling was used to select the study site and exhaustive sampling was used to select recorded participant’s data. Descriptive statistics using Statistical Package for the Social Sciences (version 26), frequency and proportions were used to organise and analyse the data. Multiple regression analyses were performed to assess the association between variables and p =.05 was considered significant.
Results: 207 Female sex workers participated in the study. Adherence to Pre-Exposure Prophylaxis was high (72.9%) but retention was low (16.9%). Unemployed female sex workers adhered more to Pre-Exposure Prophylaxis and age group 18-29 was less likely to be retained in the programme. Perception of no longer at substantial risk to Human Immuno-deficiency Virus infection, loss of interest to continue with Pre-Exposure Prophylaxis, drug side effects and busy life schedules were major reasons for non-retention.
Conclusions: Lack of motivation challenged effective Pre-Exposure Prophylaxis retention. Widespread messaging to communities and Pre-Exposure Prophylaxis scale-up are necessary to generate demand and support for Pre-Exposure Prophylaxis uptake among Female sex workers.
- Pre-exposure prophylaxis
- medication uptake
- medication adherence
- retention to care
- female sex workers
- Human Immunodeficiency Virus
How to Cite
Case KK, Johnson LF, Mahy M, Marsh K, Supervie V, Eaton JW. Summarizing the results and methods of the 2019 Joint United Nations Programme on HIV/AIDS HIV estimates. AIDS. 2019;33(Suppl 3): S197-S201. Available:https://doi:10.1097/QAD.0000000000002440.
WHO Fact Sheet. Global HIV, Hepatitis and STIs Programmes; 2019. Available:https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/populations/sex-workers.
Tanser F, de Oliveira T, Maheu-Giroux M, Bärnighausen T. Concentrated HIV sub epidemics in generalized epidemic settings. Current Opinion in HIV and AIDS. 2014;9(2):115-125. Available:https://doi:10.1097/COH.0000000000000034.
Powel VE, Gibas KM, Dubow J, Krakower DJ. Update on HIV pre-exposure prophylaxis: effectiveness, drug resistance, and risk compensation. Curr Infect Dis Rep. 2019;21(8):28. Available:https://doi: 10.1007/s11908-019-0685-6.
Krakower D, Maloney KM, Powell VE, Levine K, Grasso C, Melbourne K, et al. Patterns and clinical consequences of discontinuing HIV pre-exposure prophylaxis during primary care. J Int AIDS Soc. 2019;22(2):e25250. Available:https://doi: 10.1002/jia2.25250.
Celum CL, Delany-Moretlwe S, Baeten JM, vander Straten A, Hosek S, Bukusi EA, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(Suppl4):e25298. Available:https://doi: 10.1002/jia2.25298.
Corneli AL, Deese J, Wang M, Taylor D, Ahmed K, Agot K, et al. FEM-PrEP: Adherence patterns and factors associated with adherence to a daily oral study product for pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2014; 66(3): 324–31.
Haberer JE, Baeten JM, Campbell J, Wangisi J, Katabira E, Ronald A, et al. Adherence to antiretroviral prophylaxis for HIV prevention: a sub-study cohort within a clinical trial of sero-discordant couples in East Africa. PLoS Med. 2013;10(9): e1001511. Available:https://doi:10.1371/journal.pmed.1001511.
Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. The Lancet. 2015; 385(9962):55-71. Available:https://doi:10.1016/S0140-6736(14)60931-4.
World Health Organization. Preventing HIV in sex work settings in sub-Saharan Africa. Geneva, Switzerland: WHO; 2011. Available:https://www.afro.who.int/sites/default/files/2017-06/hiv-sw-africa-web.pdf.
Ministry of Health and Wellness. Botswana Biological and Behavioural Surveillance Survey (BBSS) of HIV/STI among select Key Populations; 2017.
Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra125. Available:https://doi:10.1126/scitranslmed.3004006.
Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med. 2015;373(23):2237-46. Available:https://doi:10.1056/NEJMoa1506273.
Baeten, J, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Partners PrEP Study Team. Antiretroviral Prophylaxis for HIV Prevention among heterosexual men and women. N Engl J Med. 2012;367(5): 399-410. Available:https://doi:10.1056/NEJMoa1108524.
McCormack S, Dunn DT, Desai M, Dolling D, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016; 387(10013):53-60. Available:https://doi:10.1016/S0140-276736(15)00056-2.
Werner RN, Gaskins M, Nast A, Dressler C. Incidence of sexually transmitted infections in men who have sex with men and who are at substantial risk of HIV infection ; a meta-analysis of data from trials and observational studies of pre-exposure prophylaxis. PLoS One. 2019; 14(12):e0226209. Available:https://doi:10.1371/journal.pone.0226209.
Cairns G. Meta-analysis finds high but variable STI rates in PrEP studies – is PrEP the cause or a potential solution?’ Aidsmap; 11 January 2019. Available:https://www.aidsmap.com/news/jan-2019/meta-analysis-finds-high-variable-sti-rates-prep-studies-prep-cause-or-potential
WHO. WHO Expands Recommendation on oral Pre-Exposure Prophylaxis (PrEP) of HIV Infection; 2015.
Cited in August 2022. Available:https://www.who.int/hiv/pub/prep/policy-brief-prep.
Ahmed N, Pike C, Bekker LG. Scaling-up pre-exposure prophylaxis in sub-Saharan Africa. Current Opinion in Infectious Diseases. 2019;32(1):24-30. Available:https://doi:10.1097/QCO.0000000000000511.
UNAIDS. On the Fast-Track to end AIDS by 2030: Focus on location and population’; 24 November 2015.
Cited in September 2022. Available:https://www.unaids.org/en/resources/documents/2015/FocusLocationPopulation
Hoagland B, Veloso VG, De Boni RB, Madruga JV, Kallas EG, Fernandes NM, Moreira RI, Liu AY, Grinsztejn B. Pre-exposure prophylaxis (PrEP) uptake and associated factors among MSM and TGW in the PrEP Brasil demonstration project. Presented at: 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention. 2015;Jul 18–22; Vancouver, Canada.
Busza J, Phillips AN, Mushati P, Chiyaka T, Magutshwa S, Musemburi S, et al. Understanding early uptake of PrEP by female sex workers in Zimbabwe. AIDS Care. 2021;33(6):729–35. Available:https://www.tandfonline.com/doi/full/10.1080/09540121.2020.1832192.Mungo, NR. Taking the leap in PrEP scale-up: a good type of challenge. Presented at the 25th Conference on Retroviruses and Opportunistic Infections (CROI). 4 - 7 March 2018; Boston, Massachusetts, USA.
Frankis JS, Young I, Lorimer K, Davis M, Flowers P. Towards preparedness for PrEP: PrEP awareness and acceptability among MSM at high risk of HIV transmission who use sociosexual media in four Celtic nations: Scotland, Wales, Northern Ireland and the Republic of Ireland: an online survey. Sexually Transmitted Infections, 2016;92(4):279-285. Available:https://doi.org/10.1136/sextrans-2015-052101
Thoma BC, Huebner DM. Brief Report: HIV Pre-exposure Prophylaxis Engagement Among Adolescent Men Who Have Sex With Men The Role of Parent–Adolescent Communication About Sex. J Acquir Immune Defic Syndr. 2018;79(4):453-457. Available:https://doi:10.1097/QAI.0000000000001837.
UNAIDS (2016) 'Prevention Gap Report' [pdf]. Cited August 2022. Available:unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf
Ministry of Health and Wellness. HIV Integrated Clinical Care Guidelines Handbook; 2016. Available:https://aidsfree.usaid.gov/sites/default/files/botswana_art_2016.pdf
Ministry of Health and Wellness. Pre-Exposure Prophylaxis Feasibility & Implementation Technical Report; October 2017.
Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-demographic characteristics and behavioural risk factors of female sex workers in sub-Saharan Africa: a systematic review. AIDS Behav. 2012; 16(4):920–933. Available:https://doi:10.1007/s10461-011-279985-z.
Burton M. Statistician General, Government of Botswana. Population and Housing Census Preliminary Results; 2022.
Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–549. Available:https://doi:10.1016/S1473-3099(12)70066-X.
Mugo PM, Sanders EJ, Mutua G, van der Elst E, Anzala O, Barin B, et al. Understanding adherence to daily and intermittent regimens of oral HIV pre-exposure prophylaxis among men who have sex with men in Kenya. AIDS Behav. 2015;19(5):794–801. Available:https://doi: 10.1007/s10461-014-0958-x.
Kirby T, Thornber-Dunwell M. Uptake of PrEP for HIV slow among MSM. Lancet. 2014;383(9915):399–400. Available:https://doi:10.1016/s0140-6736(14)60137-9.
Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Therap. 1999;21:1074–1090. Available:https://doi:10.1016/S0149-2918(99)80026-5.
Isabelle Y, Jennifer B, Susan D, Linda McCarty, Allison M. Representation in clinical trials: A review on reaching underrepresented populations in research. Clin Researcher. 2020;34(7).
Selinger C, Kirtane A, Abouzid O, Langer R, Traverso CG, Bershteyn A. Anticipated adherence, efficacy, and impact of weekly oral preexposure prophylaxis [Abstract 1035]; Conference on Retroviruses and Opportunistic Infections; February 13–16, 2017; Seattle, WA.
Eakle R, Bothma R, Bourne A, Gumede S, Motsosi K, Rees H. “I am still negative”: Female sex workers’ perspectives on uptake and use of daily pre-exposure prophylaxis for HIV prevention in South Africa. PLoS One. 2019;14(4):e0212271. Available:https://doi:10.1371/journal.pone.0212271.
Chu M, Cotler K, Yingling C. Understanding patient motivations for HIV pre-exposure prophylaxis initiation and adherence. J Am Assoc Nurse Pract. 2020;32(6):423–8. Available:https://journals.lww.com/ pmid:31453828.
Eakle R, Manthata G, Stadler J, Mbogua J, Sibanyoni M, Venter WDF, et al. Preparing for PrEP & immediate treatment: Focus group discussions in advance of a demonstration project in South Africa. AIDS Res Hum Retroviruses. 2014; 30(S1):A269–A270. Available:https://doi.org/10.1089/aid.2014.5606.abstract.
Krakower D, Mayer KH. Engaging healthcare providers to implement HIV pre-exposure prophylaxis. Curr Opin HIV AIDS. 2012;7(6):593–599. Available:https://doi:10.1097/COH.0b013e3283590446.
Silapaswan A, Krakower D, Mayer KH. Pre-exposure prophylaxis: A narrative review of provider behaviour and interventions to increase PrEP implementation in primary care. J Gen Intern Med. 2017;32(2):192–198. Available:https://doi:10.1007/s11606-016-3899-4.
Syvertsen JL, Robertson Bazzi AM, Scheibe A, Adebajo S, Strathdee SA, Wechsberg WM. The promise and peril of pre-exposure prophylaxis (PrEP): using social science to inform prep interventions among female sex workers. Afr J Reprod Health. 2014;18(3):74–83.
Eakle R, Gomez GB, Naicker N, Bothma R, Mbogua J, Cabrera Escobar MA, et al. HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: results from a prospective observational demonstration project. Plos Medicine; 2017. DOI:10.1371/journal.pmed.1002444. Available:https://doi.org/10.1371/journal.pmed.1002444
Hughey A, Hettema A, Oldenburg C, Kohler S, McMahon S, Lejeune C. Predictors of 1-month retention on PrEP for the general population in the public sector: a longitudinal study in routine care in Swaziland. In: Poster presented at the International AIDS Conference. Amsterdam; 2018.
Kyongo JK, Kiragu M, Karuga R, Ochieng C, Ngunjiri A, Wachihi C, et al. How long will they take it? Oral pre-exposure prophylaxis (PrEP) retention for female sex workers, men who have sex with men and young women in a demonstration project in Kenya. In: Journal of the International AIDS Society. 2018;21:54-55.
McKinnon L, Izulla P, Nagelkerke N, Munyao J, Wanjiru T, Shaw SY, et al. Risk factors for HIV acquisition in a prospective Nairobi-based female sex worker cohort. AIDS Behav. 2015;19(12): 2204-2213. Available:https://doi:10.1007/s10461-015-1118-7.
Chabata ST, Hensen B, Chiyaka T, Mushati P, Mtetwa S, Hanisch D, et al. Changes over time in HIV prevalence and sexual behaviour among young female sex-workers in 14 sites in Zimbabwe, 2013–2016. AIDS Behav. 2019;23(6): 1494-1507.
Reza-Paul S, Lazarus L, Doshi M, Rahman SHU, Ramaiah M, Maiya R, et al. Prioritizing risk in preparation for a demonstration project: A mixed methods feasibility study of oral Pre-Exposure Prophylaxis (PrEP) among female sex workers in South India. PLoS One. 2016;11(11):e0166889. Available:https://doi:10.1371/journal.pone.0166889
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