Cargando…

Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda

Pre-Exposure Prophylaxis (PrEP) is recommended as an additional HIV prevention measure for persons at substantial risk of HIV acquisition. Although uptake of PrEP among female sex workers (FSW) has increased, retention remains low, resulting in suboptimal benefits. This study aimed at determining Pr...

Descripción completa

Detalles Bibliográficos
Autores principales: Mubezi, Sezi, Rwibasira, Gallican N., Uwineza, Jeanne, Kayisinga, Jean de Dieu, Wandera, Manasseh G., Malamba, Samuel S., Mayora, Chrispus, Matovu, Joseph K. B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627470/
https://www.ncbi.nlm.nih.gov/pubmed/37930984
http://dx.doi.org/10.1371/journal.pgph.0002524
_version_ 1785131534509932544
author Mubezi, Sezi
Rwibasira, Gallican N.
Uwineza, Jeanne
Kayisinga, Jean de Dieu
Wandera, Manasseh G.
Malamba, Samuel S.
Mayora, Chrispus
Matovu, Joseph K. B.
author_facet Mubezi, Sezi
Rwibasira, Gallican N.
Uwineza, Jeanne
Kayisinga, Jean de Dieu
Wandera, Manasseh G.
Malamba, Samuel S.
Mayora, Chrispus
Matovu, Joseph K. B.
author_sort Mubezi, Sezi
collection PubMed
description Pre-Exposure Prophylaxis (PrEP) is recommended as an additional HIV prevention measure for persons at substantial risk of HIV acquisition. Although uptake of PrEP among female sex workers (FSW) has increased, retention remains low, resulting in suboptimal benefits. This study aimed at determining PrEP retention rates and associated factors among FSW in Kigali, Rwanda. We retrospectively studied records of 309 FSW abstracted from five (5) health centers for the period between April-June 2020 and April-June 2021. PrEP retention was defined as presenting for a scheduled follow-up visit. We used Kaplan-Meier survival analysis to estimate survival probabilities at months 1,3,6,9, and 12 post-PrEP initiation and Cox regression to determine factors associated with 12-month PrEP retention. Data was analyzed using STATA (version 14.0). Out of 309 FSW whose records were reviewed, data for 268 (87%) were complete. One half (50%, n = 133) of the respondents were aged 25–34 years; slightly more than half (52%, n = 136) were single; nearly three-quarters (73%, n = 196) had completed primary school; majority (88%, n = 236) lived alone; while 69% (n = 184) had no formal employment besides sex work. PrEP dropout rates were 228, 65, 29, 49, and 36 per 100-persons years at months 1, 3, 6, 9 and 12 respectively, with 81%, 72%, 67%, 59% and 53% of FSW that started PrEP retained at these time periods. Multivariable Cox regression revealed that compared to FSW opposed to additional children, the desire to have two or more children (adjusted Hazard Ratio [aHR] = 1.654; 95% Confidential Interval [95%CI]: 1.008, 2.713); and using hormonal (aHR = 2.091, 95%CI: 1.181, 3.702) or no method of contraception other than condoms (aHR = 2.036, 95%CI: 1.006, 4.119) were factors positively associated with PrEP retention. Conversely, compared to consistent condom-use, not using (aHR = 0.329; 95%CI: 0.149, 0.726) or inconsistently using condoms (aHR = 0.413; 95%CI: 0.228, 0.749), and accessing PrEP from ultra-urban clinics (aHR = 0.290; 95%CI: 0.183, 0.458) compared to clinics in the outskirts of the city, were factors negatively associated with PrEP retention. The study found a continuous decline in PrEP retention among FSW with slightly more than half retained at 12 months. To improve outcomes, PrEP retention monitoring should target FSW enrolled in ultra-urban clinics and those not or inconsistently using condoms.
format Online
Article
Text
id pubmed-10627470
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-106274702023-11-07 Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda Mubezi, Sezi Rwibasira, Gallican N. Uwineza, Jeanne Kayisinga, Jean de Dieu Wandera, Manasseh G. Malamba, Samuel S. Mayora, Chrispus Matovu, Joseph K. B. PLOS Glob Public Health Research Article Pre-Exposure Prophylaxis (PrEP) is recommended as an additional HIV prevention measure for persons at substantial risk of HIV acquisition. Although uptake of PrEP among female sex workers (FSW) has increased, retention remains low, resulting in suboptimal benefits. This study aimed at determining PrEP retention rates and associated factors among FSW in Kigali, Rwanda. We retrospectively studied records of 309 FSW abstracted from five (5) health centers for the period between April-June 2020 and April-June 2021. PrEP retention was defined as presenting for a scheduled follow-up visit. We used Kaplan-Meier survival analysis to estimate survival probabilities at months 1,3,6,9, and 12 post-PrEP initiation and Cox regression to determine factors associated with 12-month PrEP retention. Data was analyzed using STATA (version 14.0). Out of 309 FSW whose records were reviewed, data for 268 (87%) were complete. One half (50%, n = 133) of the respondents were aged 25–34 years; slightly more than half (52%, n = 136) were single; nearly three-quarters (73%, n = 196) had completed primary school; majority (88%, n = 236) lived alone; while 69% (n = 184) had no formal employment besides sex work. PrEP dropout rates were 228, 65, 29, 49, and 36 per 100-persons years at months 1, 3, 6, 9 and 12 respectively, with 81%, 72%, 67%, 59% and 53% of FSW that started PrEP retained at these time periods. Multivariable Cox regression revealed that compared to FSW opposed to additional children, the desire to have two or more children (adjusted Hazard Ratio [aHR] = 1.654; 95% Confidential Interval [95%CI]: 1.008, 2.713); and using hormonal (aHR = 2.091, 95%CI: 1.181, 3.702) or no method of contraception other than condoms (aHR = 2.036, 95%CI: 1.006, 4.119) were factors positively associated with PrEP retention. Conversely, compared to consistent condom-use, not using (aHR = 0.329; 95%CI: 0.149, 0.726) or inconsistently using condoms (aHR = 0.413; 95%CI: 0.228, 0.749), and accessing PrEP from ultra-urban clinics (aHR = 0.290; 95%CI: 0.183, 0.458) compared to clinics in the outskirts of the city, were factors negatively associated with PrEP retention. The study found a continuous decline in PrEP retention among FSW with slightly more than half retained at 12 months. To improve outcomes, PrEP retention monitoring should target FSW enrolled in ultra-urban clinics and those not or inconsistently using condoms. Public Library of Science 2023-11-06 /pmc/articles/PMC10627470/ /pubmed/37930984 http://dx.doi.org/10.1371/journal.pgph.0002524 Text en © 2023 Mubezi et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mubezi, Sezi
Rwibasira, Gallican N.
Uwineza, Jeanne
Kayisinga, Jean de Dieu
Wandera, Manasseh G.
Malamba, Samuel S.
Mayora, Chrispus
Matovu, Joseph K. B.
Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda
title Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda
title_full Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda
title_fullStr Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda
title_full_unstemmed Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda
title_short Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda
title_sort factors associated with retention on pre-exposure prophylaxis among female sex workers in kigali, rwanda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627470/
https://www.ncbi.nlm.nih.gov/pubmed/37930984
http://dx.doi.org/10.1371/journal.pgph.0002524
work_keys_str_mv AT mubezisezi factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda
AT rwibasiragallicann factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda
AT uwinezajeanne factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda
AT kayisingajeandedieu factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda
AT wanderamanassehg factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda
AT malambasamuels factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda
AT mayorachrispus factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda
AT matovujosephkb factorsassociatedwithretentiononpreexposureprophylaxisamongfemalesexworkersinkigalirwanda