Effect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trial

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dc.contributor.authorMujugira, Andrew
dc.contributor.authorNakyanzi, Agnes
dc.contributor.authorNabaggala, Maria S.
dc.contributor.authorMuwonge, Timothy R.
dc.contributor.authorSsebuliba, Timothy
dc.contributor.authorBagaya, Monica
dc.contributor.authorNampewo, Olivia
dc.contributor.authorSapiri, Oliver
dc.contributor.authorNyanzi, Kikulwe R.
dc.contributor.authorBambia, Felix
dc.contributor.authorNsubuga, Rogers
dc.contributor.authorSerwadda, David M.
dc.contributor.authorWare, Norma C.
dc.contributor.authorBaeten, Jared M.
dc.contributor.authorHaberer, Jessica E.
dc.date.accessioned2023-02-07T19:18:15Z
dc.date.available2023-02-07T19:18:15Z
dc.date.issued2022
dc.description.abstractHIV 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.en_US
dc.identifier.citationMujugira, 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.en_US
dc.identifier.urihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8860206/
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7635
dc.language.isoenen_US
dc.publisherJournal of acquired immune deficiency syndromesen_US
dc.subjectHIVSTen_US
dc.subjectPrEPen_US
dc.subjectAdherenceen_US
dc.subjectSex workeren_US
dc.subjectAfricaen_US
dc.titleEffect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trialen_US
dc.typeArticleen_US
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