Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

doi:10.1007/s10461-019-02705-3

Review

. 2020 May;24(5):1294-1303.

doi: 10.1007/s10461-019-02705-3.

Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

Affiliations

¹ Division of Epidemiology, College of Public Health, The Ohio State University, 334 Cunz Hall, 1841 Neil Ave, Columbus, OH, USA. lancaster.111@osu.edu.
² University of North Carolina Project-Malawi, Lilongwe, Malawi.
³ Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
⁵ Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Division of Epidemiology, College of Public Health, The Ohio State University, 334 Cunz Hall, 1841 Neil Ave, Columbus, OH, USA.

PMID: 31720955
PMCID: PMC7995177
DOI: 10.1007/s10461-019-02705-3

Review

Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

Kathryn E Lancaster et al. AIDS Behav. 2020 May.

. 2020 May;24(5):1294-1303.

doi: 10.1007/s10461-019-02705-3.

Authors

Affiliations

¹ Division of Epidemiology, College of Public Health, The Ohio State University, 334 Cunz Hall, 1841 Neil Ave, Columbus, OH, USA. lancaster.111@osu.edu.
² University of North Carolina Project-Malawi, Lilongwe, Malawi.
³ Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
⁵ Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Division of Epidemiology, College of Public Health, The Ohio State University, 334 Cunz Hall, 1841 Neil Ave, Columbus, OH, USA.

PMID: 31720955
PMCID: PMC7995177
DOI: 10.1007/s10461-019-02705-3

Abstract

Female sex workers (FSW) in Malawi have among the highest HIV prevalence estimates worldwide. Daily oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet preferences for PrEP delivery among FSW are lacking. Eight focus group discussions, a literature review, and cognitive interviews were conducted to identify modifiable PrEP delivery attributes and inform discrete-choice experiment (DCE) development for FSW in Lilongwe. Enrolled FSW received an interviewer-assisted DCE. Data were analyzed using mixed logit regression. Dispensing location was most preferred, followed by the provision of additional services. Women preferred receiving PrEP at family planning clinics or non-governmental organization run drop-in centers. Cervical cancer screening was the most preferred additional service, while pregnancy testing and partner risk reduction counseling were less valued. This study was the first study to examine PrEP delivery preferences in Malawi using DCE-a powerful elicitation tool to apply to other key populations at risk for HIV.

Keywords: Africa; Pre-exposure prophylaxis; Sex workers; Women.

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Conflict of interest statement

Conflict of interest

Authors declare that they have no conflict of interest.

Figures

**Figure I.. Sample choice task.**
Choice task shown to participants during presentation of the discrete choice experiment, in English (panel a) and Chichewa (panel b).

**Figure II.. Preferences of PrEP delivery among female sex workers in Lilongwe, Malawi (n=150).**
Panel a) Relative utilities and 95% confidence intervals between most preferred and least preferred within attributes; Panel b) Mean level utilities of attributes and standard deviations.

See this image and copyright information in PMC

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References

1. World Health Organization (WHO). Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: Recommendations for a public health approach. Geneva, Switzerland; 2013. - PubMed
1. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2012. - PubMed
1. Matovu J, Ssebadduka B. Sexual risk behaviours, condom use and sexually transmitted infection treatment-seeking behaviours among female sex workers and truck drivers in Uganda. International journal of STD & AIDS. 2012;23(4):267–73. - PubMed
1. Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan Africa: a systematic review. AIDS Behav. 2012;16(4):920–33. - PubMed
1. Vuylsteke B, Semdé G, Sika L, Crucitti T, Traoré VE, Buvé A, et al. HIV and STI Prevalence among Female Sex Workers in Côte d’Ivoire: Why Targeted Prevention Programs Should Be Continued and Strengthened. PLoS One. 2012;7(3):e32627. - PMC - PubMed

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[1] World Health Organization (WHO). Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: Recommendations for a public health approach. Geneva, Switzerland; 2013. - PubMed

[2] World Health Organization (WHO). Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: Recommendations for a public health approach. Geneva, Switzerland; 2013. - PubMed

[3] Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2012. - PubMed

[4] Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2012. - PubMed

[5] Matovu J, Ssebadduka B. Sexual risk behaviours, condom use and sexually transmitted infection treatment-seeking behaviours among female sex workers and truck drivers in Uganda. International journal of STD & AIDS. 2012;23(4):267–73. - PubMed

[6] Matovu J, Ssebadduka B. Sexual risk behaviours, condom use and sexually transmitted infection treatment-seeking behaviours among female sex workers and truck drivers in Uganda. International journal of STD & AIDS. 2012;23(4):267–73. - PubMed

[7] Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan Africa: a systematic review. AIDS Behav. 2012;16(4):920–33. - PubMed

[8] Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan Africa: a systematic review. AIDS Behav. 2012;16(4):920–33. - PubMed

[9] Vuylsteke B, Semdé G, Sika L, Crucitti T, Traoré VE, Buvé A, et al. HIV and STI Prevalence among Female Sex Workers in Côte d’Ivoire: Why Targeted Prevention Programs Should Be Continued and Strengthened. PLoS One. 2012;7(3):e32627. - PMC - PubMed

[10] Vuylsteke B, Semdé G, Sika L, Crucitti T, Traoré VE, Buvé A, et al. HIV and STI Prevalence among Female Sex Workers in Côte d’Ivoire: Why Targeted Prevention Programs Should Be Continued and Strengthened. PLoS One. 2012;7(3):e32627. - PMC - PubMed

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Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

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Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

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Conflict of interest statement

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