Enhancing Adherence Among Sex Workers through Community Led Approach

Introduction:

PrEP Demonstration Project was initiated among the Female sex workers in a brothel named Sonagachi in Kolkata, India, having more than 7000 sex workers. The objective of the study was to comprehend feasibility, acceptability of oral PrEP and to find out appropriate delivery strategy as well as to monitor and assess adherence to PrEP.

Methods:

The program was implemented by the largest sex workers’ collective named as Durbar Mahila Samanwaya Committee, and before initiating this project, sex workers were approached with a picture book by the Peer Workers (sex workers trained as health workers) to understand PrEP among the participants. The project was managed by a bunch of Peer Workers and Peer Counsellors who make visit each and every day to note their daily take of PrEP as well as enquire any issues including side effects. All participants collected medicine from the clinic meant for STI and other treatment.

Results:

Testing started from 06.01.16 and within 26.09.2016, 843 individuals were screened. 39 were ineligible as per primary ineligibility criteria of whom 14 were HIV positive, 15 were Pregnant, 9 were Hep B+ and 1 had active TB. 87 participants were suffering from other ailments like Cholelithiasis, Renal calculi, higher levels of Bilirubin etc., and were not included. 3 refused to get enrolled after testing; 36 participants could not make the deadline for recruitment as they are frequent travellers. 678 individuals were finally enrolled, of whom 78 withdrew during the whole study period of whom, 36 withdrew for various side effects, 2 were under police custody, 3 expired during the study period, 3 left for other ailments, 34 left the study area or stopped taking medicine for personal or social reasons.

141 developed some major or minor side effects like nausea, vomiting, dizziness, fatigue, body ache, skin allergy, tingling sensation in lower extremities out of which 105 restarted within one to three weeks of disappearance of symptoms. 36 (5.3%) did not join for fear of reappearance of symptoms.

600 participants were retained in the study of which 228 participants have completed 16 months of the stipulated period by the end of August 2017. Among them, 145 participants (63.6%) had adherence of 90% and above, 49 participants (21.49%) had adherence 80% and above and the remaining 34 participants (14.91%) had adherence below 80%.

Conclusion:

PrEP could be a part of combination prevention strategy through active engagement and ownership of the community.