Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach.

Autor:	Lichtwarck HO; Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway h.o.lichtwarck@medisin.uio.no., Mbotwa CH; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania., Kazaura MR; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Moen K; Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway., Mmbaga EJ; Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway.; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2023 Dec 28; Vol. 8 (12). Date of Electronic Publication: 2023 Dec 28.
DOI:	10.1136/bmjgh-2023-013662
Abstrakt:	Introduction: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool when taken as prescribed. However, suboptimal use may challenge its real-life impact. To support female sex workers in their efforts to prevent themselves from HIV, it is essential to identify factors that contribute to early disengagement from PrEP care. In this study, we aimed to estimate the risk of early disengagement from PrEP services among female sex workers in Tanzania and associated factors using a socioecological model as a guiding framework. Methods: The study was conducted as part of a pragmatic mHealth trial for PrEP roll-out in Dar es Salaam in 2021. We estimated the risk of early disengagement, defined as not presenting for the first follow-up visit (within 56 days of enrolment), and its associations with individual, social, behavioural and structural factors (age, self-perceived HIV risk, mental distress, harmful alcohol use, condom use, number of sex work clients, female sex worker stigma and mobility) using multivariable logistic regression models, with marginal standardisation to obtain adjusted relative risks (aRR). Results: Of the 470 female sex workers enrolled in the study, 340 (74.6%) did not attend the first follow-up visit (disengaged). Mental distress (aRR=1.14; 95% CI 1.01 to 1.27) was associated with increased risk of disengagement. Participants who reported a higher number of clients per month (10-29 partners: aRR=0.87; 95% CI 0.76 to 0.98 and ≥30 partners: aRR=0.80; 95% CI 0.68 to 0.91) and older participants (≥35 years) (RR=0.75; 95% CI 0.56 to 0.95) had a lower risk of disengagement. Conclusions and Recommendations: Early disengagement with the PrEP programme was high. Mental distress, younger age and having fewer clients were risk factors for disengagement. We argue that PrEP programmes could benefit from including mental health screening and treatment, as well as directing attention to younger sex workers and those reporting fewer clients. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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