Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA.
BMJ Open. 2024 Sep 5;14(9):e080218. doi: 10.1136/bmjopen-2023-080218.
Women engaging in sex work (WESW) have 21 times the risk of HIV acquisition compared with the general population. However, accessing HIV pre-exposure prophylaxis (PrEP) remains challenging, and PrEP initiation and persistence are low due to stigma and related psychosocial factors. The WiSSPr (Women in Sex work, Stigma and PrEP) study aims to (1) estimate the effect of multiple stigmas on PrEP initiation and persistence and (2) qualitatively explore the enablers and barriers to PrEP use for WESW in Lusaka, Zambia.
WiSSPr is a prospective observational cohort study grounded in community-based participatory research principles with a community advisory board (CAB) of key population (KP) civil society organi sations (KP-CSOs) and the Ministry of Health (MoH). We will administer a one-time psychosocial survey vetted by the CAB and follow 300 WESW in the electronic medical record for three months to measure PrEP initiation (#/% ever taking PrEP) and persistence (immediate discontinuation and a medication possession ratio). We will conduct in-depth interviews with a purposive sample of 18 women, including 12 WESW and 6 peer navigators who support routine HIV screening and PrEP delivery, in two community hubs serving KPs since October 2021. We seek to value KP communities as equal contributors to the knowledge production process by actively engaging KP-CSOs throughout the research process. Expected outcomes include quantitative measures of PrEP initiation and persistence among WESW, and qualitative insights into the enablers and barriers to PrEP use informed by participants' lived experiences.
WiSSPr was approved by the Institutional Review Boards of the University of Zambia (#3650-2023) and University of North Carolina (#22-3147). Participants must give written informed consent. Findings will be disseminated to the CAB, who will determine how to relay them to the community and stakeholders.
与普通人群相比，从事性工作的女性（WESW）感染 HIV 的风险高 21 倍。然而，由于污名化和相关的心理社会因素，获得 HIV 暴露前预防（PrEP）仍然具有挑战性，PrEP 的起始和持续使用率较低。WiSSPr（性工作者、污名和 PrEP）研究旨在：（1）评估多种污名对 PrEP 起始和持续使用的影响；（2）从定性角度探讨为赞比亚卢萨卡的性工作者提供 PrEP 的使用障碍和促进因素。
WiSSPr 是一项基于社区为基础的参与性研究原则的前瞻性观察队列研究，有一个由关键人群（KP）民间社会组织（KP-CSO）和卫生部（MoH）组成的社区咨询委员会（CAB）。我们将对 CAB 审查的一次性心理社会调查进行管理，并在电子病历中对 300 名性工作者进行为期三个月的随访，以衡量 PrEP 的起始（#/%曾经服用过 PrEP）和持续（立即停药和药物持有率）。我们将对自 2021 年 10 月以来为 KP 提供服务的两个社区中心的 18 名女性（包括 12 名性工作者和 6 名支持常规 HIV 筛查和 PrEP 提供的同伴导航员）进行深入访谈。我们通过在整个研究过程中积极让 KP-CSO 参与进来，努力使 KP 社区成为知识生产过程的平等贡献者。预期结果包括性工作者中 PrEP 起始和持续使用的定量措施，以及基于参与者的生活经验的关于 PrEP 使用的促进因素和障碍的定性见解。
WiSSPr 已获得赞比亚大学（#3650-2023）和北卡罗来纳大学（#22-3147）机构审查委员会的批准。参与者必须提供书面知情同意书。研究结果将传播给 CAB，CAB 将决定如何将其转达给社区和利益相关者。
