Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020
<h4>Background</h4> Despite the established efficacy of PrEP to prevent HIV and the advantages of a user-controlled method, PrEP uptake and persistence by women in both trials and demonstration projects has been suboptimal. We utilized real-world data from an HIV service provider to desc...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923438/?tool=EBI |
| _version_ | 1818284785593745408 |
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| author | Amrita Rao Hlengiwe Mhlophe Carly Comins Katherine Young Mfezi Mcingana Catherine Lesko Ntambue Mulumba Stefan Baral Harry Hausler Sheree Schwartz |
| author_facet | Amrita Rao Hlengiwe Mhlophe Carly Comins Katherine Young Mfezi Mcingana Catherine Lesko Ntambue Mulumba Stefan Baral Harry Hausler Sheree Schwartz |
| author_sort | Amrita Rao |
| collection | DOAJ |
| description | <h4>Background</h4> Despite the established efficacy of PrEP to prevent HIV and the advantages of a user-controlled method, PrEP uptake and persistence by women in both trials and demonstration projects has been suboptimal. We utilized real-world data from an HIV service provider to describe persistence on oral PrEP among female sex workers (FSW) in eThekwini, South Africa. <h4>Methods</h4> We examined time from PrEP initiation to discontinuation among all FSW initiating PrEP at TB HIV Care in eThekwini between 2016–2020. We used a discrete time-to-event data setup and stacked cumulative incidence function plots, displaying the competing risks of 1) not returning for PrEP, 2) client discontinuation, and 3) provider discontinuation. We calculated hazard ratios using complementary log-log regression and sub-hazard ratios using competing risks regression. <h4>Results</h4> The number of initiations increased each year from 155 (9.3%, n = 155/1659) in 2016 to 1224 (27.5%, n = 1224/4446) in 2020. Persistence 1-month after initiation was 53% (95% CI: 51%-55%). Younger women were more likely to discontinue PrEP by not returning compared with those 25 years and older. Risk of discontinuation through non-return declined for those initiating in later years. Despite the COVID-19 pandemic, a greater number of initiations and sustained persistence were observed in 2020. <h4>Conclusions</h4> Low levels of PrEP persistence were observed, consistent with data among underserved women elsewhere. Encouragingly, the proportion of women persisting increased over time, even as the number of women newly initiating PrEP and staff workload increased. Further research is needed to understand which implementation strategies the program may have enacted to facilitate these improvements and what further changes may be necessary. |
| first_indexed | 2024-12-13T00:58:19Z |
| format | Article |
| id | doaj.art-a3e41b6b7d474a68896fdb3d53b7ac78 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-13T00:58:19Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a3e41b6b7d474a68896fdb3d53b7ac782022-12-22T00:04:44ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01173Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020Amrita RaoHlengiwe MhlopheCarly CominsKatherine YoungMfezi McinganaCatherine LeskoNtambue MulumbaStefan BaralHarry HauslerSheree Schwartz<h4>Background</h4> Despite the established efficacy of PrEP to prevent HIV and the advantages of a user-controlled method, PrEP uptake and persistence by women in both trials and demonstration projects has been suboptimal. We utilized real-world data from an HIV service provider to describe persistence on oral PrEP among female sex workers (FSW) in eThekwini, South Africa. <h4>Methods</h4> We examined time from PrEP initiation to discontinuation among all FSW initiating PrEP at TB HIV Care in eThekwini between 2016–2020. We used a discrete time-to-event data setup and stacked cumulative incidence function plots, displaying the competing risks of 1) not returning for PrEP, 2) client discontinuation, and 3) provider discontinuation. We calculated hazard ratios using complementary log-log regression and sub-hazard ratios using competing risks regression. <h4>Results</h4> The number of initiations increased each year from 155 (9.3%, n = 155/1659) in 2016 to 1224 (27.5%, n = 1224/4446) in 2020. Persistence 1-month after initiation was 53% (95% CI: 51%-55%). Younger women were more likely to discontinue PrEP by not returning compared with those 25 years and older. Risk of discontinuation through non-return declined for those initiating in later years. Despite the COVID-19 pandemic, a greater number of initiations and sustained persistence were observed in 2020. <h4>Conclusions</h4> Low levels of PrEP persistence were observed, consistent with data among underserved women elsewhere. Encouragingly, the proportion of women persisting increased over time, even as the number of women newly initiating PrEP and staff workload increased. Further research is needed to understand which implementation strategies the program may have enacted to facilitate these improvements and what further changes may be necessary.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923438/?tool=EBI |
| spellingShingle | Amrita Rao Hlengiwe Mhlophe Carly Comins Katherine Young Mfezi Mcingana Catherine Lesko Ntambue Mulumba Stefan Baral Harry Hausler Sheree Schwartz Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020 PLoS ONE |
| title | Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020 |
| title_full | Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020 |
| title_fullStr | Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020 |
| title_full_unstemmed | Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020 |
| title_short | Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020 |
| title_sort | persistence on oral pre exposure prophylaxis prep among female sex workers in ethekwini south africa 2016 2020 |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923438/?tool=EBI |
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