Effect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trial
Loading...
Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of acquired immune deficiency syndromes
Abstract
HIV self-testing (HIVST) and pre-exposure prophylaxis
(PrEP) are complementary tools that could empower sex
workers to control their HIV protection, but few studies have jointly
evaluated PrEP and HIVST in any setting.
Methods: The Empower Study was an open-label randomized trial in
Uganda. Sex workers were offered F/tenofovir disoproxil fumarate and
randomized 1:1 to monthly HIVST and quarterly in-clinic testing
(intervention) or quarterly in-clinic HIV testing alone (standard of care)
and followed up for 12 months. PrEP adherence was measured using
electronic adherence monitoring and tenofovir diphosphate (TFV-DP)
levels in dried blood spots. Adherence outcomes and sexual behaviors
were compared by arm using generalized estimating equation models.
Results: We enrolled 110 sex workers: 84 cisgender women, 14
transgender women, 10 men who have sex with men, and 2 transgender
men. The median age was 23 years. The 12-month retention was 75%.
Nearly all (99.4%) used $1 HIVST kit. The proportion with TFV-DP
levels $700 fmol/punch in the HIVST and standard of care arms at the
3-, 6-, 9-, and 12-month visits was 2.4%, 2.3%, 0%, and 0% and 7.9%,
0%, 0%, and 0%, respectively, with no differences by randomization
arm (P . 0.2). Self-reported condomless sex acts with paying partners
was similar by arm [adjusted incidence rate ratio 0.70; 95% confidence
interval (CI): 0.42 to 1.17; P = 0.18]. One seroconversion occurred (HIV
incidence, 0.9/100 person-years); TFV-DP was not detected at any visit.
Conclusions: A gender-diverse sample of sex workers in Uganda
used HIVST but not daily oral PrEP for HIV protection. Alternate
approaches to promote PrEP use, including long-acting formulations,
should be considered in this population.
Description
Keywords
HIVST, PrEP, Adherence, Sex worker, Africa
Citation
Mujugira, A., Nakyanzi, A., Nabaggala, M. S., Muwonge, T. R., Ssebuliba, T., Bagaya, M., ... & Haberer, J. E. (2022). Effect of HIV self-testing on PrEP adherence among gender-diverse sex workers in Uganda: a randomized trial. Journal of acquired immune deficiency syndromes (1999), 89(4), 381.