Joseph Larmarange

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Joseph LARMARANGE — 2025-07-15T15:10:30Z

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Joseph Larmarange , Mélanie Plazy , Marcellin Nouaman , Evelyne Kissi , Rose-Marcelle Dedocoton , Patrick Coffie , Serge Eholié , Valentine Becquet

IAS 2025, the 13th IAS Conference on HIV Science, International AIDS Society, Jul 2025, Kigali, Rwanda

Communication dans un congrès

hal-05163730

Authors

Joseph Larmarange, Mélanie Plazy, Marcellin Nouaman, Evelyne Kissi, Rose-Marcelle Dedocoton, Patrick Coffie, Serge Eholié, Valentine Becquet

Abstract

BACKGROUND: The ANRS 12381 PRINCESSE project (11/2019-06/2023) enrolled 489 FSWs and implemented community-based sexual and reproductive health care, including PrEP, delivered through mobile clinics at prostitution sites in the San Pedro region. This presentation aims to describe PrEP trajectories and the factors associated with its use, focusing on “early adopters”.

METHODS: This analysis included 400 FSWs eligible for PrEP (HIV-negative, HBsAg-negative) enrolled up to December 2022 (>6 months of follow-up). Clinical records were analyzed to describe PrEP cascade, follow-up, and PrEP trajectories. A multivariable logistic regression identified factors associated with PrEP early adopters.

RESULTS: Although 98% of eligible FSWs were interested in PrEP, only 62% initiated PrEP, and 39% renewed it at least once.
Follow-up was very short (<6 months) for 48%, short (6-12 months) for 15%, seasonal (>12 months with a gap of 6 months between two visits) for 31%, and regular (>12 months with no gap) for 6%.
PrEP initiation was high among FSWs with regular (96%), seasonal (83%), or short (80%) follow-up, vs. 39% for those with very short follow-up. Among those who initiated, only 88% (regular), 70% (seasonal), 74% (short), and 35% (very short) renewed PrEP.
Among 148 FSWs with regular/seasonal follow-up, four PrEP trajectories were identified (cf. figure showing individual trajectories): 15% “never initiated” PrEP, 39% “initiated and were later not interested anymore”, 18% “re-initiated after non-interest”, and 28% “initiated and never expressed non-interest”, the last two groups being considered as “early adopters”. Factors associated with early PrEP adoption included the usual price of intercourse with clients <1500 FCFA (aOR=2.4 [1.2-4.8]) and working in brothels (aOR=3.2 [1.6-6.6]).


Figure presenting individual PrEP trajectories of FSWs enrolled in the PRINCESSE project

CONCLUSIONS: In PRINCESSE, loss-to-follow-up and seasonality of risks limited PrEP adoption. FSWs who were more precarious and less mobile became early adopters of this new prevention tool and could serve as potential ambassadors for promoting its uptake.

ANRS 12381 PRINCESSE @ AIDSImpact 2025: PrEP adoption & perceptions of long acting PrEP

Joseph LARMARANGE — 2025-05-30T14:21:01Z

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Joseph Larmarange , Mélanie Plazy , Marcellin Nouaman , Evelyne Kissi , Rose-Marcelle Dedocoton , Patrick Coffie , Serge Eholié , Valentine Becquet

16th AIDSImpact Conference, AIDSImpact, May 2025, Casablanca, Morocco

Communication dans un congrès

hal-05090841

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Introduction

The ANRS 12381 PRINCESSE project (November 2019 - June 2023) implemented community-based sexual and reproductive health care, including preexposure prophylaxis (PrEP), for female sex workers (FSWs) in the San Pedro region of Côte d'Ivoire, delivered through mobile clinics at prostitution sites in the San Pedro region. This presentation aims to describe PrEP trajectories and the factors associated with its use, focusing on “early adopters”.

Methods

A total of 489 women were enrolled in the PRINCESSE cohort. This analysis included 400 FSWs eligible for PrEP (HIV-negative, HBsAg-negative at baseline) enrolled up to December 2022 (i.e. enrolled at least 6 months before cohort closure). Clinical records were analyzed to describe PrEP cascade, follow-up, and PrEP trajectories. A multivariable logistic regression identified factors associated with PrEP early adopters.

Results

The overall PrEP cascade showed that although 98% of eligible FSWs were interested in PrEP, only 62% initiated PrEP, and 39% renewed it at least once.

Follow-up was very short (<6 months) for 48% of FSWs, short (6-12 months) for 15%, seasonal (>12 months with a gap of 6 months between two visits) for 31%, and regular (>12 months with no gap) for 6%.

PrEP initiation was high among FSWs with regular (96%), seasonal (83%), or short (80%) follow-up, vs. 39% for those with very short follow-up. Among those who initiated, only 88% (regular), 70% (seasonal), 74% (short), and 35% (very short) renewed PrEP.

Among 148 FSWs with regular/seasonal follow-up, four PrEP trajectories were identified (cf. attached figure showing individual trajectories, each line representing a participant's PrEP journey): 15% never initiated PrEP; 39% initiated PrEP before stopping and expressing they were not interested anymore; 18% re-initiated PrEP after an episode of non-interest”; and 28% initiated and never expressed non-interest at a later stage. The last two groups were considered as “early adopters”. Significant factors associated with early PrEP adoption were the usual price of intercourse with clients <1500 FCFA (i.e. 2.3 EUR) (aOR=2.4 [1.2-4.8]) and working in brothels (aOR=3.2 [1.6-6.6]).

Conclusions

In PRINCESSE, loss-to-follow-up and seasonality of risks limited PrEP adoption. FSWs who were more precarious and less mobile became early adopters of this new prevention tool and could serve as potential ambassadors for promoting its uptake and demand creation.

Perception de la Prophylaxie préexposition à longue durée d'action chez les travailleuses du sexe et les HSH à San Pedro et Abidjan, Côte d'Ivoire

Evelyne Kissi , Joseph Larmarange , Rose-Marcelle Dedocoton , Mélanie Plazy , Marcellin Nouaman , Patrick Coffie , Serge Eholié , Valentine Becquet

16th AIDSImpact Conference, AIDSImpact, May 2025, Casablanca, Maroc

Communication dans un congrès

hal-05090784

Perception de la Prophylaxie préexposition à longue durée d'action chez les travailleuses du sexe et les HSH à San Pedro et Abidjan, Côte d'Ivoire

Introduction : Des recherches ont montré que l'utilisation et l'adhésion à la PrEP par voie orale peuvent être complexes au sein de certaines populations, telles que les travailleuses du sexe (TS) et les hommes ayant des relations sexuelles avec d'autres hommes (HSH), notamment en raison de leur grande mobilité, d'une vie quotidienne imprévisible ou d'effets secondaires. Dans ce contexte, la PrEP à longue durée d'action (actuellement à différents stades de développement), telle que les injectables, le gel, les implants, les suppositoires vaginaux, les douches vaginales/anales ou les anneaux vaginaux, pourraient contribuer à surmonter certaines difficultés rencontrées avec la PrEP orale. Cette étude visait à explorer les perceptions de ces formulations à longue durée d'action parmi les TS et les HSH en Côte d'Ivoire.

Méthodologie : Inscrite dans le projet ANRS 12381 PRINCESSE, cette sous-étude qualitative a été menée en novembre-décembre 2023 au sein de deux ONG communautaires : Aprosam à San Pedro et Espace Confiance à Abidjan auprès des TS et HSH. Au total, 32 TS (19 naïves de PrEP et 13 expérimentées) et 12 HSH (3 naïfs de PrEP et 9 expérimentés) ont été interrogés (lors de14 entretiens individuels et 5 focus groups). Une analyse thématique s'est concentrée sur l'aspect pratique, la discrétion, l'autonomie, l'efficacité perçue et les effets secondaires anticipés des différentes formulations de PrEP à longue durée d'action.

Résultats : Les participants ont généralement exprimé des opinions favorables à l'égard de la PrEP à longue durée d'action, considérée comme une forme moins contraingrante que la PrEP par voie orale. Les injections ont été particulièrement appréciées pour leur discrétion (pas de marque visible), les injections semestrielles étant préférées. Quelques inquiétudes ont été exprimées quant à la douleur liée à l'injection. Le gel, assimilé à un lubrifiant, a séduit par sa double fonction de protection et de plaisir. Toutefois, certains participants ont exprimé des doutes quant à son efficacité. Bien que la durée d'action de l'implant (1 an) ait été appréciée, elle n'a pas été plébiscitée en raison du manque de discrétion (cicatrice) et des effets secondaires potentiels anticipés. L'autonomie et la facilité d'utilisation des suppositoires vaginaux sont perçues comme avantageuses, à condition que les conditions d'hygiène soient optimales ; les HSH font le parallèle avec les suppositoires anaux. Même si les douches vaginales sont largement pratiquées par les TS, la lotion de nettoyage intime de la PrEP a reçu des réactions mitigées de la part des TS, conscientes des risques d'un usage excessif. Enfin, l'anneau vaginal a suscité peu d'intérêt en raison de la méconnaissance de l'outil.

Conclusion : Dans l'ensemble, la PrEP à longue durée d'action peut offrir des options alternatives pour la prévention du VIH. Les éléments clés favorisant l'adoption à un format (PrEP à longue durée d'action) sont la facilité d'utilisation, un suivi simplifié (le moins souvent possible), des règles claires pour le démarrage et l'arrêt, la discrétion, l'efficacité perçue et les effets secondaires anticipés.

VIH : des solutions préventives à longue durée prometteuses

Joseph LARMARANGE — 2024-12-02T17:58:04Z

VIH : des solutions préventives à longue durée prometteuses

Louise Hurel , Christian Laurent , Joseph Larmarange , Karna Coulibaly

2024

Article de blog scientifique

hal-04815258

La PrEP avec le lénacapavir injectable est une solution efficace et prometteuse pour les populations vulnérables, à condition d'être accessible.

Des outils de prévention toujours plus efficaces et moins contraignants, adaptés aux conditions de vie et besoins réels des populations les plus exposées : voilà le nerf de la guerre contre le VIH. Parmi eux, la PrEP avec le lénacapavir nourrit de grands espoirs comme outil de prévention. Ce médicament est déjà utilisé pour soigner les patients ayant développé des résistances aux traitements les plus courants. Deux études viennent de démontrer qu'il était également pleinement efficace pour empêcher les nouvelles infections, à raison d'une injection sous-cutanée tous les six mois. Une révolution dans le domaine de la prévention !

En quoi le lénacapavir injectable peut apporter une solution pérenne ? À qui et sous quelles conditions ?

Explications avec trois scientifiques impliqués dans des projets de recherche auprès de populations clés : Christian Laurent, épidémiologiste IRD à TransVIHMI, coordinateur du projet CohMSM-PrEP, centré sur les hommes ayant des rapports sexuels avec les hommes (HSH) en Afrique de l'Ouest ; Joseph Larmarange, démographe IRD au Ceped, coordinateur du projet Princesse auprès de travailleuses du sexe en Côte d'Ivoire ; et Karna Coulibaly, démographe Ined et chercheur associé au Ceped, impliqué dans le projet Makasi qui a été réalisé auprès d'immigrés d'Afrique subsaharienne en situation de précarité vivant en Île-de-France.

PRINCESSE @ AIDS 2024 in Munich

Joseph LARMARANGE — 2024-07-23T15:46:03Z

AIDS 2024, the 25^th International AIDS Conference, was in Munich from 22 to 26 July 2024. Four posters were selected on abstract. In addition, main results from the ANRS 12381 PRINCESSE project were presented and discussed on the stand France.

Vulnerability and psychological distress of female sex workers in Côte d'Ivoire

Hasna Youssoufa , Marcelin N'Zebo Nouaman , Charlotte Bernard , Valentine Becquet , Patrick Coffie , Aline Agoua , Serge Eholié , Joseph Larmarange , Mélanie Plazy

AIDS 2024, the 25th International AIDS Conference, Jul 2024, Munich, Germany.

Poster de conférence

hal-04660379

‘Dirt just has to come down': body perceptions and lived experiences of female sex workers in Côte d'Ivoire (ANRS 12361 PrEP-CI and ANRS 12381 PRINCESSE projects)

Valentine Becquet , Evelyne Kissi , Mélanie Plazy , Marcelin N'Zebo Nouaman , Patrick Coffie , Aline Agoua , Serge Eholié , Joseph Larmarange

AIDS 2024, the 25th International AIDS Conference, Jul 2024, Munich, Germany.

Poster de conférence

hal-04660389

Facilitators and barriers to the enrolment and retention of female sex workers in a sexual health cohort (ANRS 12381 PRINCESSE) in San-Pedro, Côte d'Ivoire

Evelyne Kissi , Rose-Marcelle Dedocoton , Marcelin N'Zebo Nouaman , Mélanie Plazy , Patrick Coffie , Aline Agoua , Joseph Larmarange , Valentine Becquet

AIDS 2024, the 25th International AIDS Conference, Jul 2024, Munich, Germany.

Poster de conférence

hal-04660360

“We used to treat a bit blindly: it was a syndromic diagnosis”. Physicians' perceptions of comprehensive management of sexually transmitted infections among sex workers in Côte d'Ivoire

Marcelin N'Zebo Nouaman , Patrick Coffie , Mélanie Plazy , Valentine Becquet , Serge Eholié , Joseph Larmarange

AIDS 2024, the 25th International AIDS Conference, Jul 2024, Munich, Germany.

Poster de conférence

hal-04660367

ANRS 12381 PRINCESSE @ AFRAVIH 2024

Joseph LARMARANGE — 2024-04-09T16:46:34Z

La 12^e Conférence Internationale Francophone AFRAVIH s'est tenue du 16 au 19 avril 2024 à Youndé.

Session SP06 - Antirétroviraux : prévention et traitements 17 avril 2024 à 15h

« C'est difficile de la prendre tous les jours » : Initiations, arrêts précoces et perceptions de la prophylaxie pré-exposition (PrEP) orale parmi les travailleuses du sexe en Côte d'Ivoire

Valentine Becquet , Mélanie Plazy , Evelyne Kissi , Marcellin Nouaman , Patrick Coffie , Aline Agoua , Serge Eholié , Joseph Larmarange

12e Conférence Internationale Francophone AFRAVIH, AFRAVIH, Apr 2024, Yaoundé, Cameroun

Communication dans un congrès

hal-04539829

Session SP10 - Santé mentale 17 avril 2024 à 15h

Vulnérabilité et détresse psychologique des travailleuses du sexe en Côte d'Ivoire

Hasna Youssoufa , Marcellin Nouaman , Charlotte Bernard , Valentine Becquet , Patrick Coffie , Aline Agoua , Serge Eholié , Joseph Larmarange , Mélanie Plazy

12e Conférence Internationale Francophone AFRAVIH, AFRAVIH, Apr 2024, Yaoundé, Cameroun

Communication dans un congrès

hal-04539824

Session SP12 - Sciences humaines et sociales - Session Sandrine Musso 18 avril 2024 à 10h

Facilitateurs et freins à l'adhésion et au maintien des travailleuses du sexe dans une cohorte de santé sexuelle (projet ANRS 12381 Princesse) à San-Pedro en Côte d'Ivoire

Evelyne Kissi , Rose-Marcelle Dedocoton , Marcellin Nouaman , Mélanie Plazy , Patrick Coffie , Aline Agoua , Joseph Larmarange , Valentine Becquet

12e Conférence Internationale Francophone AFRAVIH, AFRAVIH, Apr 2024, Yaoundé, Cameroun

Communication dans un congrès

hal-04539831

Session SP17 - Santé sexuelle 2 18 avril 2024 à 15h

« Avant on traitait un peu à l'aveugle, c'était un diagnostic syndromique. » Perceptions des médecins dans une prise en charge globale des infections sexuellement transmissibles chez des travailleuses du sexe en Côte d'Ivoire

Marcellin Nouaman , Evelyne Kissi , Patrick Coffie , Mélanie Plazy , Valentine Becquet , Serge Eholié , Joseph Larmarange

12e Conférence Internationale Francophone AFRAVIH, AFRAVIH, Apr 2024, Yaoundé, Cameroun

Communication dans un congrès

hal-04539834

What does the scale-up of long-acting HIV pre-exposure prophylaxis mean for the global hepatitis B epidemic?

Joseph LARMARANGE — 2024-03-06T10:52:27Z

What does the scale‐up of long‐acting HIV pre‐exposure prophylaxis mean for the global hepatitis B epidemic?

Amir Mohareb , Menan Gérard Kouamé , Marcellin Nouaman , Arthur Kim , Joseph Larmarange , Anne Neilan , Karine Lacombe , Kenneth A Freedberg , Anders Boyd , Patrick Coffie , Emily Hyle

Journal of the International AIDS Society, 2024, 27 (3), pp.e26218. ⟨10.1002/jia2.26218⟩

Article dans une revue

hal-04491666

Authors

Amir M. Mohareb, Menan Gérard Kouamé, Marcellin Nouaman, Arthur Y. Kim, Joseph Larmarange, Anne M. Neilan, Karine Lacombe, Kenneth A. Freedberg, Anders Boyd, Patrick Coffie, Emily P. Hyle

Abstract

Introduction

The HIV and hepatitis B virus (HBV) epidemics are interconnected with shared routes of transmission and specific antiviral drugs that are effective against both viruses. Nearly, 300 million people around the world live with chronic HBV, many of whom are from priority populations who could benefit from HIV prevention services. Oral pre-exposure prophylaxis (PrEP) for HIV has implications in the prevention and treatment of HBV infection, but many people at increased risk of HIV acquisition may instead prefer long-acting formulations of PrEP, which are currently not active against HBV.

Discussion

People at increased risk for HIV acquisition may also be at risk for or already be living with HBV infection. Oral PrEP with tenofovir is effective in preventing both HIV and HBV, and tenofovir is also the recommended treatment for chronic HBV infection. Although implementation of oral PrEP has been challenging in sub-Saharan Africa, investments in its scale-up could secondarily reduce the clinical impact of HBV. Long-acting PrEP, including injectable medicines and implantable rings, may overcome some of the implementation challenges associated with oral PrEP, such as daily pill burden, adherence challenges and stigma; however, current formulations of long-acting PrEP do not have activity against HBV replication. Ideally, PrEP programmes would offer both oral and long-acting formulations with HBV screening to optimize HIV prevention services and HBV prevention and care, when appropriate. People who are not immune to HBV would benefit from being vaccinated against HBV before initiating long-acting PrEP. People who remain non-immune to HBV despite vaccination may benefit from being offered oral, tenofovir-based PrEP given its potential for HBV PrEP. People using PrEP and living with HBV who are not linked to dedicated HBV care would also benefit from laboratory monitoring at PrEP sites to ensure safety when using and after stopping tenofovir. PrEP programmes are ideal venues to offer HBV screening, HBV vaccination for people who are non-immune and treatment with tenofovir-based PrEP for people with indications for HBV therapy.

Conclusions

Long-acting PrEP holds promise for reducing HIV incidence, but its implications for the HBV epidemic, particularly in sub-Saharan Africa, should not be overlooked.

Transforming effective innovations into efficient interventions: contributions from social and implementation sciences

Joseph LARMARANGE — 2023-11-30T17:00:02Z

Transforming effective innovations into efficient interventions: contributions from social and implementation sciences

Joseph Larmarange

40 years of HIV science, Institut Pasteur; ANRS|MIE, Nov 2023, Paris, France

Communication dans un congrès

hal-04316678

Abstract

The history of the fight against AIDS has been marked by the development of major scientific and biomedical innovations: antiretroviral treatments, rapid screening tests, pre-exposure prophylaxis... However, these innovations have often been insufficient on their own to curve the epidemics. It has also been essential to innovate in terms of funding, organisation of services and care, advanced “out-of-hospital” strategies, human rights, taking account of the specific characteristics of the most vulnerable populations, etc.

Effective innovation will be ineffective if it is not adapted to the social, cultural, and legal constraints faced by populations and to the structural, organisational, and economic constraints of healthcare systems. Hence the need for a genuine science of implementation that is necessarily interdisciplinary and intersectoral.

PrEP among female sex workers: where are we? A literature review identifying knowledge gaps to guide the future research agenda

Joseph LARMARANGE — 2023-06-14T15:00:00Z

Oral communication presented the 14^th of June, 2023, at AIDS Impact conference in Stockholm, Sweden.

PrEP among female sex workers: where are we? A literature review identifying knowledge gaps to guide the future research agenda

Mélanie Plazy , Valentine Becquet , Esther Maouhoub , Carla Meertens , Remi Mouquin , Hasna Youssoufa , Marcellin Nouaman , Patrick Coffie , Joseph Larmarange

AIDS Impact Conference, Jun 2023, Stockholm, Sweden

Communication dans un congrès

hal-04120001

Authors

Mélanie Plazy, Valentine Becquet, Esther Maouhoub, Carla Meertens, Rémi Mouquin, Hasna Youssoufa, Marcellin Nouaman, Patrick Coffie, Joseph Larmarange

Abstract

Objectives. In 2015, the WHO recommended HIV pre-exposure prophylaxis (PrEP) for people at substantial risk of being infected by HIV, but also highlighted the need for research projects to improve PrEP implementation and follow-up, especially among female sex workers (FSW). While many studies have been published on PrEP among men who have sex with men, the literature is far less important among FSW. We aim to summarise the overall published literature on PrEP among FSW worldwide to display the challenges and facilitators of PrEP implementation in this population and highlight the knowledge gaps.

Methods. We have conducted a systematic literature review searching Pubmed, Web of Sciences, Scopus, SocINDEX, APA PsycArticles, APA PsycInfo, Psychology and Behavioral Sciences Collection, until 31 December 2022. All manuscripts on PrEP in FSW were included worldwide, regardless of the primary outcome, the type of PrEP (oral, topical or long-acting), the study design, or the type of data collection. Titles and abstracts were independently screened by three reviewers, and full texts by two reviewers. We excluded papers: not presenting specific or stratified results on FSW; study protocols; conference abstracts; not written in English or French. Two independent reviewers then reviewed each included study to extract: Unaids region, country, study type, outcomes (see description in the results), type of PrEP, and study years. The results of the included papers will be analysed in more detail by one reviewer for each type of outcome.

Results. Among the 412 published references identified through the search equation after duplicate removal, 198 were excluded based on the title and abstract, and 69 were excluded after full-text reading. Among the 145 papers included, n=10 were commentaries, n=17 literature reviews on global HIV prevention or including several populations, n=3 country case studies, n=24 modelling studies and n=91 other original papers. Among the latest, n=51 studies were conducted in Eastern and Southern Africa, n=13 in Western and Central Africa, n=11 in Asia and the Pacific, n=9 in Western and Central Europe and North America, n=7 in Latin America and the Caribbean; no studies were conducted in the Middle East and North Africa or Eastern Europe and Central Asia. The majority (n=85) were about oral PrEP. Regarding outcomes, n=39 were on knowledge/awareness, n=42 on willingness/interest, n=38 on attitudes/perceptions/beliefs, n=42 on uptake/use, n=21 on retention, n=23 on adherence, n=4 on efficacy/effectiveness, n=3 on epidemiological impacts, n=18 on behavioural impacts, n=5 on social impacts, n=10 on delivery models, n=9 on costs. Specific results for each type of outcome is in progress. Preliminary results suggest high PrEP willingness among FSW, but specific challenges regarding oral PrEP uptake and retention in this population.

Discussion. The overall literature on PrEP focusing on FSW is relatively scarce (compared to more than 1850 references on PrEP among men who have sex with men identified on Pubmed by the end of 2022). The final results of this literature review will be available by May 2023. They will allow to guide the future research agenda regarding the implementation of biomedical HIV prevention among FSW.

“It's hard to take it every day”: initiations, discontinuations & perceptions of oral preexposure prophylaxis among female sex workers in Côte d'Ivoire

Joseph LARMARANGE — 2023-06-12T15:00:00Z

Oral communication presented the 12^th of June, 2023, at AIDS Impact conference in Stockholm, Sweden.

“It's hard to take it every day”: initiations, discontinuations & perceptions of oral preexposure prophylaxis among female sex workers in Côte d'Ivoire

Valentine Becquet , Mélanie Plazy , Evelyne Kissi , Marcellin Nouaman , Patrick Coffie , Serge Eholié , Joseph Larmarange

AIDS Impact Conference, Jun 2023, Stockhlom, Sweden

Communication dans un congrès

hal-04119974

Authors

Valentine Becquet, Mélanie Plazy, Evelyne Kissi, Marcellin Nouaman, Patrick A. Coffie, Serge Eholié, Joseph Larmarange

Abstract

Introduction/objective(s)

The paper aims to describe oral preexposure prophylaxis (PrEP) initiations and discontinuations among female sex workers (FSWs) in Côte d'Ivoire, and to elaborate broader considerations about their perceptions, through barriers and facilitators of PrEP use.

Methods

The ANRS 12381 PRINCESSE project provides a comprehensive sexual and reproductive healthcare package, including PrEP, among a cohort of FSWs aged ≥18 years in the San Pedro region. This package is offered in a community clinic and through a mobile clinic operating on 10 prostitution sites (visited every two weeks) for 45 months (12/2019-06/2023). The analysis is based on qualitative interviews with 38 FSWs conducted in December 2019, September 2021, March and May 2022, and clinical records related to PrEP use filled out by the physicians.

Results

Interviews showed that many women identified the protective effect of PrEP against HIV despite sometimes being afraid of side effects. Few women reported perceiving no benefit of PrEP compared to condoms.

End-February 2023, 406 HIV- and HBV-negative women were included: 388 (96%) declared their interest in PrEP. Among them, 218 (56%) exited care within 6 weeks, 4 were not interested in PrEP anymore, and only 165 (43%) initiated PrEP.

In interviews, some women explained having stopped PrEP immediately because of side effects. Some women also reported having stopped PrEP after a few weeks because of their difficulties in taking a daily treatment at a fixed time. FSWs also shared that a major reason for PrEP discontinuation is related to periods of mobility when they leave to visit their families and no longer work. These women sometimes re-initiated PrEP, but not immediately after starting sex work again.

Among the 165 FSWs who initiated PrEP, 60 (36%) attended their first PrEP follow-up visit, of whom 16 (27%) reported having discontinued PrEP. Among the latest, 4 (25%) reported not being interested anymore. The other 12 and the 44 who did not discontinue PrEP received a second prescription. At each subsequent visit of PrEP follow-up, a part of the women reported PrEP discontinuation, and some decided to stop PrEP.

More broadly, the confidence in PrEP is not total among women interviewed. Some reported rumours and fear of being identified as HIV-positive among colleagues. Others used simultaneously other means to protect against HIV, such as enema after condomless sex, because PrEP is taken once a day and not after each intercourse.

Discussion/conclusion/implications

Although loss to follow-up was a major issue, it was not the only barrier to PrEP initiation and retention. Despite high levels of interest in PrEP, PrEP discontinuation was frequent, partly linked to periods of mobility.

Oral daily PrEP is not a magic bullet: it sometimes appears difficult for FSWs to articulate PrEP with other daily priorities. FSWs regularly evaluate the balance between constraints and benefits at each step of the process. In this specific population of FSWs, there is an urgent need to find new ways of simplifying HIV biomedical prevention.

PrEP injectable dans les pays à ressources limitées, promesses et défis

Joseph LARMARANGE — 2023-04-27T14:17:37Z

PrEP injectable dans les pays à ressources limitées, promesses et défis

Joseph Larmarange

2023

Article de blog scientifique

ird-04083902

Une étude de modélisation publiée fin 2022 tente de répondre, pour le cas sud-africain, à deux questions : quels seraient les impacts de santé publique d'un programme de PrEP injectable par rapport à un programme de PrEP orale ? à quel coût de la PrEP injectable celle-ci serait-elle plus coût-efficace que la PrEP orale ?

Joseph Larmarange

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Authors

Abstract

See also

Perceptions regarding long-acting pre-exposure prevention (PrEP) among female sex workers and men having sex with men in San Pedro and Abidjan, Côte d'Ivoire

ANRS 12381 PRINCESSE @ AIDSImpact 2025: PrEP adoption & perceptions of long acting PrEP

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Perception de la Prophylaxie préexposition à longue durée d'action chez les travailleuses du sexe et les HSH à San Pedro et Abidjan, Côte d'Ivoire

Perception de la Prophylaxie préexposition à longue durée d'action chez les travailleuses du sexe et les HSH à San Pedro et Abidjan, Côte d'Ivoire

VIH : des solutions préventives à longue durée prometteuses

VIH : des solutions préventives à longue durée prometteuses

PRINCESSE @ AIDS 2024 in Munich

Vulnerability and psychological distress of female sex workers in Côte d'Ivoire

‘Dirt just has to come down': body perceptions and lived experiences of female sex workers in Côte d'Ivoire (ANRS 12361 PrEP-CI and ANRS 12381 PRINCESSE projects)

Facilitators and barriers to the enrolment and retention of female sex workers in a sexual health cohort (ANRS 12381 PRINCESSE) in San-Pedro, Côte d'Ivoire

“We used to treat a bit blindly: it was a syndromic diagnosis”. Physicians' perceptions of comprehensive management of sexually transmitted infections among sex workers in Côte d'Ivoire

ANRS 12381 PRINCESSE @ AFRAVIH 2024

« C'est difficile de la prendre tous les jours » : Initiations, arrêts précoces et perceptions de la prophylaxie pré-exposition (PrEP) orale parmi les travailleuses du sexe en Côte d'Ivoire

Vulnérabilité et détresse psychologique des travailleuses du sexe en Côte d'Ivoire

Facilitateurs et freins à l'adhésion et au maintien des travailleuses du sexe dans une cohorte de santé sexuelle (projet ANRS 12381 Princesse) à San-Pedro en Côte d'Ivoire

« Avant on traitait un peu à l'aveugle, c'était un diagnostic syndromique. » Perceptions des médecins dans une prise en charge globale des infections sexuellement transmissibles chez des travailleuses du sexe en Côte d'Ivoire

What does the scale-up of long-acting HIV pre-exposure prophylaxis mean for the global hepatitis B epidemic?

What does the scale‐up of long‐acting HIV pre‐exposure prophylaxis mean for the global hepatitis B epidemic?

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Abstract

Transforming effective innovations into efficient interventions: contributions from social and implementation sciences

Transforming effective innovations into efficient interventions: contributions from social and implementation sciences

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PrEP among female sex workers: where are we? A literature review identifying knowledge gaps to guide the future research agenda

PrEP among female sex workers: where are we? A literature review identifying knowledge gaps to guide the future research agenda

Authors

Abstract

“It's hard to take it every day”: initiations, discontinuations & perceptions of oral preexposure prophylaxis among female sex workers in Côte d'Ivoire

“It's hard to take it every day”: initiations, discontinuations & perceptions of oral preexposure prophylaxis among female sex workers in Côte d'Ivoire

Authors

Abstract

PrEP injectable dans les pays à ressources limitées, promesses et défis

PrEP injectable dans les pays à ressources limitées, promesses et défis