Early and Long-Term Retention in Facility-Based HIV Pre-Exposure Prophylaxis Service Delivery Model Among Women at High Risk of HIV Acquisition in Tanga, Tanzania

Abstract

Introduction: Retention in HIV pre-exposure prophylaxis (PrEP) care among key populations is crucial to realize its benefits. Evidence is scarce on retention in PrEP care outcomes and associated factors among at-risk women in sub-Saharan Africa. We, therefore, evaluated the retention outcomes in the facility-based PrEP services delivery model and their associated factors among female sex workers in the city of Tanga, Tanzania. Methods: We analyzed data of 313 female sex workers of a control arm of a pragmatic trial. Participants were followed for 16 months from 2022 to 2023. We categorized retention in care outcomes PrEP services as being early and long-term. A multivariable log-binomial regression model was used to determine factors affecting retention in PrEP services at p<0.05. Results: Early and long-term retention in PrEP care was 38.0% (95% CI: 33.25-43.04) and 11.0% (95% CI: 7.67-15.61), respectively. Having sex work as the only source of income negatively affected early retention compared to those with alternative sources of income (aRR 0.58, 95% CI: 0.36-0.94, p=0.028). Having 10-29 sexual clients/month was 34% times lower risk of being retained compared to those with less than 10 sexual clients per month (aRR 0.66, 95% CI: 0.47-0.92, p=0.014). Self-perceived "high" PrEP stigma negatively affected long-term retention compared to perceiving "low" PrEP stigma (aRR 0.16, 95% CI: 0.03-0.99, p=0.049) and self-perceived "moderate" HIV risk was associated with increased retention compared to self-perceived "high" HIV risk (aRR 5.03, 95% CI: 1.37-18.47, p=0.015). Conclusion: The retention in facility-based HIV PrEP care among female sex workers was low. Having sex work as the only source of income, having sex with 10-29 clients, and self-perceived "high" PrEP stigma negatively affected retention in PrEP care. Self-perceived "moderate" HIV risk positively affected retention in PrEP care. Establishing client-centred approaches targeting PrEP stigma and HIV risk awareness is crucial to optimize retention in facility-based PrEP services. Trial Registration: Pan African Clinical Trials Registry PACTR202003823226570.