부산대학교 도서관

Background: India has the second largest HIV epidemic worldwide with more than 2.3 million people living with HIV. However, PrEP uptake lags far behind countries with comparable epidemics. India's first PrEP demonstration project completed in 2018 in Karnataka and West Bengal indicated feasibility, safety, high adherence, and willingness to continue on daily oral PrEP among urban female sex workers (N=1,325). The current study is the first to characterize determinants of PrEP method preferences among a gender-diverse sample of sex workers in both urban and rural India. Methods: From August 2019 to February 2020, we surveyed 133 female sex workers (FSW), 49 male sex workers (MSW), and 51 transgender sex workers (TGSW) and conducted seven focus groups with sex workers in West Bengal, India. Confirmatory factor analysis was used to construct and validate a novel 7-item PrEP Acceptability Scale (Cronbach's alpha=0.73), which was highly correlated with a single item on willingness to take oral PrEP (r=0.60). Multiple linear regression was used to model determinants of PrEP acceptability. Conditional logistic regression with a gender by stigma interaction term was used to assess preferences for long-acting injectable versus oral PrEP. Results: Although most participants (87%) reported willingness to take PrEP as a daily oral pill, 90% of MSW and 88% of TGSW were worried that their partners might think they already have HIV if they started PrEP, and 61% and 71%, respectively, did not want their partners to know if they started PrEP. In contrast, < 30% of FSW reported either stigma concern. As such, preference for injectable PrEP was higher among TGSW (75%) and MSW (76%) than FSW (39%). When stratifying by gender, odds of preferring injectable PrEP were 30 times higher among MSW and 21 times higher among TGSW who reported both stigma concerns. Conclusion: Our findings highlight the importance of offering a variety of PrEP products to meet the needs of specific key populations. Gender transformative interventions to combat PrEP stigma among sex workers in India should be prioritized to ensure that high PrEP acceptability is translated into uptake and adherence, particularly among MSW and TGSW, who bear a disproportionate burden of HIV. [ABSTRACT FROM AUTHOR]