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The PrEP Care Continuum Among Cisgender Women Who Sell Sex and/or Use Drugs Globally: A Systematic Review

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Abstract

HIV prevalence among cisgender female sex workers (FSW) and/or women who use drugs (WWUD) is substantially higher compared to similarly aged women. Consistent with PRISMA guidelines, we conducted the first systematic review on the pre-exposure prophylaxis (PrEP) continuum among FSW and/or WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting a PrEP related result among FSW and/or WWUD aged 18 + ; peer-reviewed; and published in English between 2012 and 2018. Our search identified 1365 studies; 26 met eligibility requirements, across the following groups: FSW (n = 14), WWUD (n = 9) and FSW-WWUD (n = 3). Studies report on at least one PrEP outcome: awareness (n = 12), acceptability (n = 16), uptake (n = 4), and adherence (n = 8). Specific barriers span individual and structural levels and include challenges to daily adherence, cost, and stigma. Combining health services and long-acting PrEP formulas may facilitate better PrEP uptake and adherence. The limited number of studies indicates a need for more research.

Resumen

La prevalencia del VIH es sustancialmente mayor entre trabajadoras sexuales cisgénero (FSW) y/o mujeres que usan drogas (WWUD) en comparación con mujeres de edad similar. Siguiendo PRISMA, realizamos la primera revisión sistemática sobre el continuo de la Profilaxis Preexposición (PrEP) entre estos grupos. Los criterios de elegibilidad fueron: informar un resultado de PrEP entre FSWs y/o WWUDs con mayores de edad; que haya pasado por revisión de pares; y publicados en inglés entre el 2012 y el 2018. Identificamos 1365 estudios; 26 cumplieron los criterios: FSW (n = 14), WWUD (n = 9) y FSW-WWUD (n = 3). Los estudios nos informaron sobre: conocimiento (n = 12), aceptabilidad (n = 16), uso, (n = 4) y adherencia (n = 8). Las barreras incluyen la adherencia, el costo, y el estigma. La combinación de los servicios de salud y de PrEP de acción-prolongada pueden facilitar mejor uso y adherencia a la PrEP. El número limitado de estudios indica la necesidad de más investigación.

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Abbreviations

aOR:

Adjusted odds ratio

ART:

Antiretroviral therapy

CI:

Confidence interval

FDA:

Food and Drug Administration

FSW:

Female sex workers

FSW-WWUD:

Female sex workers who are also women who use drugs

IDU:

Injection drug users

LMIC:

Lower and middle income countries

MSM:

Men who have sex with men

MPT:

Multipurpose technologies

PrEP:

Pre-exposure prophylaxis

PWID:

People who inject drugs

PWUD:

Persons who use drugs

RCT:

Randomized control trial

SEP:

Syringe exchange program

STIs:

Sexually transmitted infections

TDF/FTC:

Tenofovir and emtricitabine medication

WHO:

World Health Organization

WWID:

Women who inject drugs

WWUD:

Women who use drugs

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Acknowledgements

We thank the authors of the included studies. We also thank Kenneth Morales, MPH for his assistance in the title abstract review process. This work was supported by the NIH/NIDA (R34DA045619-02), the Drug Dependence Epidemiology Training Program, NIH/NIDA (T32DA007292), the Johns Hopkins University Hopkins Population Center (R24HD042854) and the Johns Hopkins Center for AIDS Research.

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Authors and Affiliations

  1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Jennifer L. Glick

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Rienna Russo

  3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Belinda Jivapong

  4. Welch Medical Library, Johns Hopkins University, Baltimore, MD, USA

    Lori Rosman

  5. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Jennifer L. Glick, Danielle Pelaez, Katherine H. A. Footer & Susan G. Sherman

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Glick, J.L., Russo, R., Jivapong, B. et al. The PrEP Care Continuum Among Cisgender Women Who Sell Sex and/or Use Drugs Globally: A Systematic Review. AIDS Behav 24, 1312–1333 (2020). https://doi.org/10.1007/s10461-019-02733-z

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