Uptake and Persistence on HIV Pre-Exposure Prophylaxis Among Female Sex Workers and Men Having Sex with Men in Kigali, Rwanda: A Retrospective Cross-Sectional Study Design

BACKGROUND: Although HIV pre-exposure prophylaxis (PrEP) is known for its effectiveness in preventing HIV transmission; there is a global rise in HIV infection rates, particularly prominent in sub-Saharan Africa. This health concern is mostly evident among high-risk groups, namely Female Sex Workers (FSWs) and Men who have Sex with Men (MSMs), both of whom are more susceptible to sexually transmissible infections. This research examined the persistence, uptake, and associated predictors of PrEP utilization within the FSW and MSM populations. METHODS: A cross-sectional study design was conducted involving 4872 individuals from the FSW and MSM groups who were enrolled in a PrEP program across 10 health centers participating in a pilot initiative. The study population was subject to a year-long follow-up period commencing on March 1st, 2019. To evaluate the determinants of PrEP utilization within FSW and MSM groups, bivariate logistic analyses and multivariate logistic regression models were employed. RESULTS: The findings revealed that the occurrence of PrEP uptake was 45.55% (n=2219) among FSWs and 35.42% (n=17 participants) among MSM. Regarding PrEP persistence, MSM (88.24%, n=15 participants) presented higher PrEP proportion than FSWs (78.5%, n=1742 women). Our findings disclosed that individuals aged 25–34 years (aOR=0.82; 95% CI=0.72–0.93, p=0.002), 35–44 years (aOR=0.83; 95% CI=0.71–0.97, p=0.017), and 55 years and older (OR=0.14; 95% CI=0.04–0.48, p=0.002) exhibited lower likelihoods of having low PrEP uptake than those aged 15–19 years. Moreover, individuals residing with their families (aOR=0.71; 95% CI=0.58–0.87, p<0.001), living with roommates (aOR=0.7; 95% CI=0.5–0.97, p=0.032) displayed lower odds for experiencing low PrEP uptake than their counterparts living alone. CONCLUSION: This study highlighted the low uptake of PrEP among participants when compared to previous studies. These results revealed significant influences of age and living conditions on PrEP usage.