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Prioritizing Risk in Preparation for a Demonstration Project: A Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) among Female Sex Workers in South India.
PLoS One. 2016; 11(11):e0166889.Plos

Abstract

BACKGROUND

HIV prevalence among female sex workers (FSWs) in India remains well above the national average. Pre-exposure prophylaxis (PrEP), a new HIV prevention technology, may help to reduce HIV incidence, but there is a dearth of research that can inform the potential scale-up of PrEP in India. In partnership with Ashodaya Samithi, a local sex worker collective, we conducted a feasibility study to assess acceptance of a planned PrEP demonstration project, willingness to use PrEP, and recommendations for project roll-out among FSWs in southern Karnataka.

METHODS

From January-April 2015, 6 focus group discussions, 47 in-depth interviews, and 427 interviewer-administered questionnaires were completed by female sex workers. All participants were 18 years of age or older and practiced sex work. Qualitative data were coded for key themes and emergent categories. Univariate descriptive analysis was employed to summarise the quantitative data.

RESULTS

Qualitative. PrEP was described as an exciting new prevention technology that places control in the hands of FSWs and provides a "double safety" in combination with condom use. Participants expressed agreement that women who may experience more HIV risk in their occupational environments should be prioritized for enrollment into a demonstration project. Quantitative. 406 participants (95%) expressed interest in PrEP. Participants prioritized the inclusion of FSWs under the age of 25 (79%), those who do not use condoms when clients offer more money (58%), who do not consistently use condoms with regular partners (57%), who drink alcohol regularly (49%), and who do not use condoms consistently with clients (48%).

DISCUSSION

This feasibility study indicated strong interest in PrEP and a desire to move forward with the demonstration project. Participants expressed their responses in terms of public health discourses surrounding risk, pointing to the importance of situating PrEP scale up within the trusted spaces of community-based organizations as a means of supporting PrEP uptake and adherence.

Authors+Show Affiliations

Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.Ashodaya Samithi, Mysore, India.Ashodaya Samithi, Mysore, India.Ashodaya Samithi, Mysore, India.Ashodaya Samithi, Mysore, India.Ashodaya Samithi, Mysore, India.Independent Consultant, Chennai, India.Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27880833

Citation

Reza-Paul, Sushena, et al. "Prioritizing Risk in Preparation for a Demonstration Project: a Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) Among Female Sex Workers in South India." PloS One, vol. 11, no. 11, 2016, pp. e0166889.
Reza-Paul S, Lazarus L, Doshi M, et al. Prioritizing Risk in Preparation for a Demonstration Project: A Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) among Female Sex Workers in South India. PLoS ONE. 2016;11(11):e0166889.
Reza-Paul, S., Lazarus, L., Doshi, M., Hafeez Ur Rahman, S., Ramaiah, M., Maiya, R., Ms, V., Venukumar, K. T., Sundararaman, S., Becker, M., Moses, S., & Lorway, R. (2016). Prioritizing Risk in Preparation for a Demonstration Project: A Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) among Female Sex Workers in South India. PloS One, 11(11), e0166889. https://doi.org/10.1371/journal.pone.0166889
Reza-Paul S, et al. Prioritizing Risk in Preparation for a Demonstration Project: a Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) Among Female Sex Workers in South India. PLoS ONE. 2016;11(11):e0166889. PubMed PMID: 27880833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prioritizing Risk in Preparation for a Demonstration Project: A Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) among Female Sex Workers in South India. AU - Reza-Paul,Sushena, AU - Lazarus,Lisa, AU - Doshi,Monika, AU - Hafeez Ur Rahman,Syed, AU - Ramaiah,Manjula, AU - Maiya,Raviprakash, AU - Ms,Venugopal, AU - Venukumar,K T, AU - Sundararaman,Sundar, AU - Becker,Marissa, AU - Moses,Stephen, AU - Lorway,Robert, Y1 - 2016/11/23/ PY - 2016/07/04/received PY - 2016/11/04/accepted PY - 2016/11/24/entrez PY - 2016/11/24/pubmed PY - 2017/6/24/medline SP - e0166889 EP - e0166889 JF - PloS one JO - PLoS ONE VL - 11 IS - 11 N2 - BACKGROUND: HIV prevalence among female sex workers (FSWs) in India remains well above the national average. Pre-exposure prophylaxis (PrEP), a new HIV prevention technology, may help to reduce HIV incidence, but there is a dearth of research that can inform the potential scale-up of PrEP in India. In partnership with Ashodaya Samithi, a local sex worker collective, we conducted a feasibility study to assess acceptance of a planned PrEP demonstration project, willingness to use PrEP, and recommendations for project roll-out among FSWs in southern Karnataka. METHODS: From January-April 2015, 6 focus group discussions, 47 in-depth interviews, and 427 interviewer-administered questionnaires were completed by female sex workers. All participants were 18 years of age or older and practiced sex work. Qualitative data were coded for key themes and emergent categories. Univariate descriptive analysis was employed to summarise the quantitative data. RESULTS: Qualitative. PrEP was described as an exciting new prevention technology that places control in the hands of FSWs and provides a "double safety" in combination with condom use. Participants expressed agreement that women who may experience more HIV risk in their occupational environments should be prioritized for enrollment into a demonstration project. Quantitative. 406 participants (95%) expressed interest in PrEP. Participants prioritized the inclusion of FSWs under the age of 25 (79%), those who do not use condoms when clients offer more money (58%), who do not consistently use condoms with regular partners (57%), who drink alcohol regularly (49%), and who do not use condoms consistently with clients (48%). DISCUSSION: This feasibility study indicated strong interest in PrEP and a desire to move forward with the demonstration project. Participants expressed their responses in terms of public health discourses surrounding risk, pointing to the importance of situating PrEP scale up within the trusted spaces of community-based organizations as a means of supporting PrEP uptake and adherence. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27880833/Prioritizing_Risk_in_Preparation_for_a_Demonstration_Project:_A_Mixed_Methods_Feasibility_Study_of_Oral_Pre_Exposure_Prophylaxis__PREP__among_Female_Sex_Workers_in_South_India_ L2 - http://dx.plos.org/10.1371/journal.pone.0166889 DB - PRIME DP - Unbound Medicine ER -