Uptake, Adherence and Retention of Daily Oral Pre-Exposure Prophylaxis among Female Sex Workers in the Greater Gaborone City, Botswana

Introduction: Female sex workers are estimated to be 30 times more likely to be living with Human Immuno-deficiency Virus than other women of reproductive age and face an increased burden of sexually transmitted infections. Pre-Exposure Prophylaxis was introduced in Botswana in 2018 as an addition to combination-prevention strategies. Since then, no study was carried out to assess the efficiency of PrEP as an intervention. This study aimed to assess the uptake, adherence and retention of daily oral Pre-Exposure Prophylaxis among female sex workers in the Greater Gaborone City, Botswana.

Methods: Retrospective, quantitative cross-sectional study was carried out Between August 2018 and May 2020. Purposive sampling was used to select the study site and exhaustive sampling was used to select recorded participant’s data. Descriptive statistics using Statistical Package for the Social Sciences (version 26), frequency and proportions were used to organise and analyse the data. Multiple regression analyses were performed to assess the association between variables and p =.05 was considered significant.

Results: 207 Female sex workers participated in the study. Adherence to Pre-Exposure Prophylaxis was high (72.9%) but retention was low (16.9%). Unemployed female sex workers adhered more to Pre-Exposure Prophylaxis and age group 18-29 was less likely to be retained in the programme. Perception of no longer at substantial risk to Human Immuno-deficiency Virus infection, loss of interest to continue with Pre-Exposure Prophylaxis, drug side effects and busy life schedules were major reasons for non-retention.

Conclusions: Lack of motivation challenged effective Pre-Exposure Prophylaxis retention. Widespread messaging to communities and Pre-Exposure Prophylaxis scale-up are necessary to generate demand and support for Pre-Exposure Prophylaxis uptake among Female sex workers.