Uptake and retention of pre-exposure prophylaxis among female sex workers in Zimbabwe. Case study (Population Services International in Zimbabwe)

Abstract

Uptake and retention-in-care to pre-exposure prophylaxis (PrEP) are major requirements to successfully optimise treatment benefits. The failure to monitor and link clients from HIV testing to HIV care and retain them in care until they are eligible for PrEP is a major barrier to early PrEP initiation. This study evaluated the retention in PrEP program of HIV-negative female sex workers (FSWs) clients who are using PrEP as their HIV prevention method in Zimbabwe. People who are at high risk of obtaining HIV infection use PrEP program. The objective of the study was to determine factors significant in contributing to attrition in PrEP uptake as well as to find ways to prevent loss to follow-up on FSWs who are on PrEP program. The study used retrospective data from New Africa House (NAH) a new start centre in Harare. Out of 3200 HIV-negative FSWs clients enrolled into PrEP program (during 1 May 2016 to 30 June 2018), 1042(32.56%) FSWs clients were retained in care and were active in care at the end of observation period. Lost to follow up FSWs were 2158 (67.44%). Retention was defined as remaining connected to PrEP program once entered until transfer-out to continue care elsewhere. Logistic regression and Cox proportional hazards was used to assess the significance of factors contributing to attrition and act as predictive model. Cox proportional hazards model was used for attrition and P < 0.05 used to determine statistical significance. There was 67.4% reduction in risk of lost to follow up among those who started PrEP. Socio-demographic characteristics, marital status, employment, education and age were associated with lost to follow up (P > 0.05). Retention in PrEP program care was somewhat poor. Uptake of PrEP significantly improved retention. Majority of FSWs who are lost to follow up occurred in first year of PrEP program care. Close monitoring and tracking of clients during this period is recommended. PSI/ZIM should decentralize the facilities, as this would both lighten the current burden for FSW clients who live far away, reduce the opportunity costs related to travel, which in turn would make follow-up appointments easier. The researcher also recommends introducing an indicator in the monthly report for monitoring retention and/or attrition among PrEP clients. Keywords: Retention; Pre- exposure prophylaxis; FSWs; PSIZIM.