ArticleThe lancet. HIV2023
Effect of implementation strategies on pre-exposure prophylaxis persistence among female sex workers in South Africa: an interrupted time series study.
Article in The lancet. HIV, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 9 citations in OpenAlex.
- Patterns and Predictors of HIV Pre-exposure Prophylaxis (PrEP) Continuity Among Young Women Who Sell Sex in Uganda: A Group-Based Trajectory Modeling Approach.AIDS and behavior · 2026Article
- "It would have been easier for me to give up if I were alone": how a pilot individualized case management intervention influenced female sex workers' oral HIV pre-exposure prophylaxis use in eThekwini, South Africa.BMC public health · 2026Article
- Let Them Talk: Coping with PrEP-Related Stigma and Sustaining PrEP Persistence Among Men Who Have Sex with Men in Tanga, Tanzania.Healthcare (Basel, Switzerland) · 2026Article
- One Month Preexposure Prophylaxis Retention Rate and Associated Factors Among Adolescent Girls and Young Women Who Participated in the Namibia DREAMS Program (2018-2024).Infectious disease reports · 2025Article
- Effect of the implementation of HIV/AIDS prevention and treatment policies on the mortality rate of people living with HIV in Guilin, China.Scientific reports · 2025Article
- Challenges and Opportunities in Big Data Science to Address Health Inequities and Focus the HIV Response.Current HIV/AIDS reports · 2024Review
- Oral pre-exposure prophylaxis implementation in South Africa: a case study of USAID-supported programs.Frontiers in reproductive health · 2024Article
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
backgroundA disproportionate number of new HIV infections in South Africa are among female sex workers; pre-exposure prophylaxis (PrEP) for HIV prevention is freely available to female sex workers in the country, but unique barriers challenge PrEP persistence. TB HIV Care, a large South African non-profit organisation that provides daily oral PrEP (tenofovir disoproxil fumarate and emtricitabine), has implemented multiple strategies to improve PrEP persistence. We aimed to evaluate the effect of different implementation strategies on PrEP persistence in a large-scale real-world setting.
methodsIn this interrupted time series study, we estimated level changes in 1-month oral PrEP persistence associated with roll-out of various implementation strategies among female sex workers across nine districts in South Africa. We used routinely collected data from TB HIV Care programme files from June 7, 2016, to April 30, 2021. Poisson regression of 1-month persistence was used to assess the effect of these strategies. In secondary analyses, we tested the association between each of the strategies and 4-month persistence.
findingsThe median 1-month PrEP persistence for female sex workers was 33% (IQR 27-40). SMS support and refill reminders were associated with an 11% relative increase in 1-month persistence (risk ratio [RR] 1·11, 95% CI 1·02-1·26) and clinical mentoring for PrEP providers was associated with a 127% relative increase (RR 2·27, 95% CI 1·94-2·66) among female sex workers. The loyalty rewards programme was negatively associated with 1-month persistence (RR 0·71, 95% CI 0·67-0·83). Although clinical mentoring improved 4-month persistence, SMS support text messages had no significant effect.
interpretationIdentification and subsequent use of clinical mentoring for PrEP providers and SMS support and refill reminders might improve the usefulness of PrEP overall to prevent new HIV infections among female sex workers. PrEP persistence remains an important issue, and strategies to build on our findings are needed.
fundingNational Institute of Mental Health and National Institute of Allergy and Infectious Diseases.
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