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Interim feasibility results of a pre-exposure prophylaxis (PrEP) delivery demonstration project among male sex workers in Malindi, Kenya

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BACKGROUND: Despite overwhelming scientific evidence supporting use of pre-exposure prophylaxis (PrEP) for HIV prevention, the reality of providing PrEP and ensuring adherence remain a challenge for highly marginalized persons in resource poor settings. This study was conducted to evaluate the feasibility and acceptability of a peer-driven, community-based PrEP program for male sex workers (MSWs) in Malindi, Kenya.
METHODS: This 15-month demonstration project engaged MSWs "³ 18 years old in Malindi, Kenya via peer-leader led, venue-based sampling (i.e. at local hotspots). Working with a local organization supporting LGBTQIA persons, MSW were screened for eligibility using the PrEP Rapid Assessment Screening Tool (RAST). Eligible participants received were prescribed a monthly and then quarterly supply of PrEP and scheduled for monthly follow-up visits for PrEP refills. Data on PrEP related concerns and perceived barriers to adherence were collected as well as self-reported adherence at a midpoint and final study visit.
RESULTS: Between May 2019 to October 2019, n=200 MSW (mean age = 27.0 years, SD= 6.6 years; range = 18 ' 51) met study eligibility criteria and were enrolled in this project and n=195 (97.5%) were retained over the course of the study period. Preliminary results indicate that at baseline, PrEP concerns were about long-term health effects (37%), side effects (38%) and daily adherence (27%). Despite these concerns, on average, >90% of participants returned as scheduled to obtain PrEP refills and self-reported adherence was reported by >80% of participants.
CONCLUSIONS: While follow-up and data collection activities are still in progress, important lessons can be drawn from these preliminary findings. First, employing a peer leader model to engage MSW in a PrEP demonstration project was critical to successfully recruiting, enrolling and retaining MSW. Next, by employing a community participatory model based on collaborating with a a local and well-established LGBTQIA support organization, our preliminary findings strongly suggest that locating PrEP delivery services within health service organizations that are sex-worker friendly can significantly facilitate adoption of HIV prevention among male sex workers. Finally, these findings will be important for successfully scaling-up community-based PrEP delivery and sexual health services to MSW in Malindi, Kenya.