Mixed-methods protocol for the WiSSPr study: Women in Sex work, Stigma and psychosocial barriers to Pre-exposure prophylaxis in Zambia

• Published in: BMJ open Vol. 14; no. 9; p. e080218
• Main Authors: Kumar, Ramya, Rao, Deepa, Sharma, Anjali, Phiri, Jamia, Zimba, Martin, Phiri, Maureen, Zyambo, Ruth, Kalo, Gwen Mulenga, Chilembo, Louise, Kunda, Phidelina Milambo, Mulubwa, Chama, Ngosa, Benard, Mugwanya, Kenneth K, Barrington, Wendy E, Herce, Michael E, Musheke, Maurice
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 05.09.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Community-Based Participatory Research; Disease prevention; Drug use; Electronic health records; EPIDEMIOLOGIC STUDIES; Female; Health Equity; Health services; HIV; HIV & AIDS; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Medical records; MENTAL HEALTH; Observational Studies as Topic; Pharmacy; Pre-Exposure Prophylaxis - methods; Prospective Studies; Protocol; QUALITATIVE RESEARCH; Research Design; Sex industry; Sex Workers - psychology; Sexual Health; SOCIAL MEDICINE; Social Stigma; Stigma; Systematic review; Womens health; Zambia; Zambia; MENTAL HEALTH; EPIDEMIOLOGIC STUDIES; Health Equity; HIV & AIDS; QUALITATIVE RESEARCH; SOCIAL MEDICINE
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-080218

IntroductionWomen engaging in sex work (WESW) have 21 times the risk of HIV acquisition compared with the general population. However, accessing HIV pre-exposure prophylaxis (PrEP) remains challenging, and PrEP initiation and persistence are low due to stigma and related psychosocial factors. The WiSSPr (Women in Sex work, Stigma and PrEP) study aims to (1) estimate the effect of multiple stigmas on PrEP initiation and persistence and (2) qualitatively explore the enablers and barriers to PrEP use for WESW in Lusaka, Zambia.Methods and analysisWiSSPr is a prospective observational cohort study grounded in community-based participatory research principles with a community advisory board (CAB) of key population (KP) civil society organi sations (KP-CSOs) and the Ministry of Health (MoH). We will administer a one-time psychosocial survey vetted by the CAB and follow 300 WESW in the electronic medical record for three months to measure PrEP initiation (#/% ever taking PrEP) and persistence (immediate discontinuation and a medication possession ratio). We will conduct in-depth interviews with a purposive sample of 18 women, including 12 WESW and 6 peer navigators who support routine HIV screening and PrEP delivery, in two community hubs serving KPs since October 2021. We seek to value KP communities as equal contributors to the knowledge production process by actively engaging KP-CSOs throughout the research process. Expected outcomes include quantitative measures of PrEP initiation and persistence among WESW, and qualitative insights into the enablers and barriers to PrEP use informed by participants’ lived experiences.Ethics and disseminationWiSSPr was approved by the Institutional Review Boards of the University of Zambia (#3650-2023) and University of North Carolina (#22-3147). Participants must give written informed consent. Findings will be disseminated to the CAB, who will determine how to relay them to the community and stakeholders.