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<p>Young women who sell sex (YWSS) in Africa are particularly vulnerable to HIV acquisition and may benefit from daily oral pre-exposure prophylaxis (PrEP) but face multiple barriers to uptake. We identified temporal patterns of PrEP continuity/retention and associated characteristics within a cohort of YWSS in Uganda. Cisgender women aged 18–24&#xa0;years who exchanged sex for money, goods, or services were recruited into a PrEP demonstration study in peri-urban Mukono District. We used group-based trajectory modeling to discern temporal patterns of PrEP continuity over 12&#xa0;months of follow-up and multinomial logistic regression to identify baseline predictors of PrEP retention trajectories. Among 833 YWSS initiating PrEP, a four-group trajectory model emerged as best-fitting: (1) <i>Rapid PrEP discontinuity</i> (39.7%), characterized by high PrEP program attrition by 3&#xa0;months; (2) <i>Delayed PrEP discontinuity</i> (24.2%), characterized by PrEP continuation through 6&#xa0;months; (3) <i>Immediate PrEP discontinuity</i> (19.1%), characterized by high PrEP discontinuation in the month following initiation; and (4) <i>High PrEP continuity</i> (17.0%), characterized by sustained PrEP engagement throughout follow-up. In general, shorter- and longer-term PrEP continuation was associated with older age, higher education, pre-coital alcohol/drug use, and having 10 + paying partners in the past 3&#xa0;months. Perceived HIV risk and related HIV vulnerabilities helped distinguish observed PrEP retention trajectories, predicting the timing of PrEP discontinuation among YWSS.</p>

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Patterns and Predictors of HIV Pre-exposure Prophylaxis (PrEP) Continuity Among Young Women Who Sell Sex in Uganda: A Group-Based Trajectory Modeling Approach

  • 期刊论文

  • 发表日期：

    2025年12月23日

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  • Joseph G. Rosen,
  • Amrita Rao,
  • Hannah Kibuuka,
  • Betty Mwesigwa,
  • Grace Mirembe,
  • Ezra Musingye,
  • Amal Abdulrahman,
  • Stefan D. Baral,
  • Trevor A. Crowell,
  • Eniko E. Akom,
  • Katherine B. Rucinski

摘要

Young women who sell sex (YWSS) in Africa are particularly vulnerable to HIV acquisition and may benefit from daily oral pre-exposure prophylaxis (PrEP) but face multiple barriers to uptake. We identified temporal patterns of PrEP continuity/retention and associated characteristics within a cohort of YWSS in Uganda. Cisgender women aged 18–24 years who exchanged sex for money, goods, or services were recruited into a PrEP demonstration study in peri-urban Mukono District. We used group-based trajectory modeling to discern temporal patterns of PrEP continuity over 12 months of follow-up and multinomial logistic regression to identify baseline predictors of PrEP retention trajectories. Among 833 YWSS initiating PrEP, a four-group trajectory model emerged as best-fitting: (1) Rapid PrEP discontinuity (39.7%), characterized by high PrEP program attrition by 3 months; (2) Delayed PrEP discontinuity (24.2%), characterized by PrEP continuation through 6 months; (3) Immediate PrEP discontinuity (19.1%), characterized by high PrEP discontinuation in the month following initiation; and (4) High PrEP continuity (17.0%), characterized by sustained PrEP engagement throughout follow-up. In general, shorter- and longer-term PrEP continuation was associated with older age, higher education, pre-coital alcohol/drug use, and having 10 + paying partners in the past 3 months. Perceived HIV risk and related HIV vulnerabilities helped distinguish observed PrEP retention trajectories, predicting the timing of PrEP discontinuation among YWSS.