Factors Associated with Usage of Oral-PrEP among Female Sex Workers in Nairobi, Kenya, Assessed by Self-Report and a Point-of-Care Urine Tenofovir Immunoassay

• Published in: AIDS and behavior Vol. 28; no. 11; pp. 3836 - 3849
• Main Authors: Shah, Pooja, Spinelli, Matthew, Irungu, Erastus, Kabuti, Rhoda, Ngurukiri, Pauline, Babu, Hellen, Kungu, Mary, Champions, The Maisha Fiti Study, Nyabuto, Chrispo, Mahero, Anne, Devries, Karen, Kyegombe, Nambusi, Medley, Graham F., Gafos, Mitzy, Seeley, Janet, Weiss, Helen A., Kaul, Rupert, Gandhi, Monica, Beattie, Tara S., Kimani, Joshua
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2024; Springer Nature B.V
• Subjects: Aggression; Children; Domestic violence; Education; Elementary education; Females; Health care; Health care industry; Health Psychology; Health services; Help seeking behavior; HIV; Human immunodeficiency virus; Immunoassay; Infectious Diseases; Intimate partner violence; Medicine; Medicine & Public Health; Occupational exposure; Original Paper; Policy making; Prophylaxis; Prostitution; Public Health; Regression analysis; Regression models; Secondary education; Self report; Sex industry; Sex workers; Sexually transmitted diseases; STD; Stigma; Substance abuse; Substance use; Tenofovir; Violence; Nairobi Kenya; Kenya; Female sex workers; Hierarchical modelling; HIV prevention; PrEP; Kenya; Adolescent girls and young women
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-024-04455-3

Pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV acquisition. We aimed to estimate usage of oral-PrEP, and factors associated with adherence among female sex workers (FSWs) in Nairobi, Kenya, using a novel point-of-care urine tenofovir lateral flow assay (LFA). The Maisha Fiti study randomly selected FSWs from Sex Worker Outreach Program clinics in Nairobi. Data were collected from 1003 FSWs from June-October 2019, including surveys on self-reported oral-PrEP adherence. Adherence was also measured using the LFA for HIV-negative FSWs currently taking oral-PrEP. Informed by a social-ecological theoretical framework, we used hierarchical multivariable logistic regression models to estimate associations between individual, interpersonal/community, and structural/institutional-level factors and either self-reported or LFA-assessed adherence. Overall, 746 HIV-negative FSWs aged 18–40 participated in the study, of whom 180 (24.1%) self-reported currently taking oral-PrEP. Of these, 56 (31.1%) were adherent to oral-PrEP as measured by LFA. In the multivariable analyses, associations with currently taking oral-PrEP included having completed secondary education, high alcohol/substance use, feeling empowered to use PrEP, current intimate partner, no recent intimate partner violence, having support from sex worker organisations, experiencing sex work-related stigma, and seeking healthcare services despite stigma. Associations with oral-PrEP LFA-measured adherence measured included having only primary education, experience of childhood emotional violence, belonging to a higher wealth tertile, and being nulliparous. Oral-PrEP adherence, measured by self-report or objectively, is low among FSWs in Nairobi. Programs to improve oral-PrEP usage among FSWs should work to mitigate social and structural barriers and involve collaboration between FSWs, healthcare providers and policymakers.