Page 134 - HIVMED_v21_i1.indb

Page 2 of 6 Original Research

during the period an individual is at risk of contracting HIV their location in a certain area) provided referrals to enable
4
infection. Zimbabwe has adopted The Joint United Nations further recruitment and mobilisation of other FSWs. This
Programme on HIV and AIDS 90-90-90 global goals to help technique was utilised because of laws and policies that
5
reduce new infections and end the HIV pandemic. This criminalise sex work in Zimbabwe. Female sex workers
target will be difficult to reach without reducing transmission were also identified during community outreach HIV
amongst high-incidence populations. testing and counselling activities by the PVO. Once
identified, FSWs were asked to provide written consent and
Although it is well established that effective PrEP could to complete a 48-item questionnaire. The questionnaire was
provide an additional safety net to sexually active persons at administered by the interviewer. The questionnaire had
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risk, limited data are available in Zimbabwe regarding the sections enquiring about socio-demographic factors, sexual
knowledge and the likelihood of PrEP use amongst FSWs. behavioural characteristics, HIV testing, PrEP knowledge,
There is a need to understand both the acceptability of PrEP perceptions, barriers and the likelihood of its use. Sexual
amongst FSWs and the factors likely to determine uptake. behavioural characteristics were investigated to determine
Most research efforts to date have focussed on clinical aspects the HIV acquisition risk profile of the FSWs. The interviews
of PrEP. Little attention has been focussed on the factors that were conducted in the language that the participant was
influence FSWs’ willingness to take it. It is estimated that most comfortable with. ‘Sufficient knowledge’ was judged
there are 40 000 (plausibility bounds [PBs] 28 000–59 000) by means of an initial self-report and an additional nine
active FSWs in Zimbabwe, that is, 1.23% (PB: 0.86% – 1.79%) technical questions designed to test the level of knowledge.
of the adult female population. A total of 20 000 (50%) are in These technical questions included the participant’s
Harare and Bulawayo. This study was conducted to assess knowledge that PrEP is used by HIV-negative individuals,
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the levels of knowledge, barriers to and likelihood of oral the dosing frequency, potential drug interactions and
PrEP use amongst FSWs as a preventative method in reducing whether there are other reproductive health benefits. Once
the risk of acquiring HIV in Harare, Zimbabwe. the level of knowledge was ascertained, the participants
were then educated about PrEP use. The perceived barriers
Methods that were evaluated included stigma, cost of PrEP and the
Study design and setting side-effects of Truvada.

This was a cross-sectional study of FSWs in seven peri-urban Data management and statistical analysis
areas of Harare province, Zimbabwe. These sites were
specifically chosen because they are high-density areas, and Research Electronic Data Capture (REDCap) was used to
apart from the central business district, they are areas from manage data. This was hosted by the College of Health
which FSWs frequently operate. 8 Sciences of the University of Zimbabwe. The contribution of
each factor, namely, age, cost of PrEP and drug side-effects,
Study population and recruitment with regard to improving PrEP uptake amongst FSWs was
examined. The importance of each factor as perceived by
This cross-sectional study was conducted between December the respondents was assessed by computing the relative
2016 and February 2017 in partnership with a local private importance index (RII). The RII is a statistical measure
voluntary organisation (PVO) that offers PrEP services. The recorded on a scale of 0 < RII ≤ 1, where ‘0’ or any value
TM
PVO had been offering PrEP using TDF/FTC (Truvada )
tablets as an HIV prevention method in six Zimbabwean close to ‘0’ is defined as a poor knowledge of PrEP use, the
districts since August 2016. This was a demonstration project participant is less likely to use PrEP or barriers associated
introduced to inform people of the new HIV prevention with PrEP are likely to affect uptake. If the RII score was ‘1’
strategy of the MoHCC. The primary target populations or close to ‘1’, it means that participants were knowledgeable
included adolescent girls and young women aged 15–24 about PrEP, were more likely to use PrEP and that barriers
years, FSWs, MSM and serodiscordant couples. 9 associated with PrEP use were unlikely to affect its uptake.

=
Human immunodeficiency virus–negative FSWs were defined The RII was computed using the equation RII ∑ Scorei × 100%,
Kn
as those who had been tested for HIV in the previous where Score was the score for each question given by the
i
3 months and had tested negative or those who perceived participants and ranged from 0 to 4 (where ‘0’ was ‘very
themselves to be HIV-negative. The PrEP intervention that is much disagree, strongly disagree or never’ and ‘4’ was
defined for the purpose of this study refers to oral PrEP with ‘strongly agree, very much agree or almost always’). K was
Truvada, which is indicated for ‘at-risk’ individuals with a the maximum possible score and n was the total number
laboratory-confirmed HIV-negative result. None of the of questions. According to Johnson and LeBreton, RII is the
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participants was already receiving PrEP from the PVO.
proportionate contribution each predictor makes to R
2
2
Snowball sampling was used to locate and enrol FSWs from (where R is the extent to which the dependent variable can
the peri-urban Harare sites. A peer referral system whereby be predicted by the predictor variables), considering both its
‘seed’ subjects previously identified by the PVO and ‘queens’ direct effect (correlation with the dependent variable) and its
(the leaders of a significant group of sex workers based on effect when combined with other variables.

http://www.sajhivmed.org.za 126 Open Access