{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:26:59Z","timestamp":1782221219977,"version":"3.54.5"},"reference-count":24,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"crossref","award":["163878"],"award-info":[{"award-number":["163878"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"crossref","award":["320030_192452"],"award-info":[{"award-number":["320030_192452"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,11,12]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, but its impact is limited by low uptake and poor continuation rates. This study investigates oral PrEP continuation among key populations (KPs) enrolled in an HIV prevention programme across seven states in Nigeria, representing one of the largest longitudinal PrEP continuation studies in Sub-Saharan Africa to date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from 43\u2009788 clients who initiated daily oral PrEP between January 2020 and March 2023. The sample comprised female sex workers (20 574, 47.0%), men who have sex with men (12 946, 29.6%), people who inject drugs (9462, 21.6%) and transgender individuals (806, 1.8%). The primary outcome was 6-month PrEP continuation, defined as having a recorded PrEP refill more than 6 months after initiation. We used multivariable mixed-effects logistic regression to identify factors associated with PrEP continuation; the model included KP group, age, education, occupation, marital status and time since PrEP initiation and accounted for clustering at the facility level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 43\u2009788 clients initiating PrEP, the 6-month continuation rate was 11.5%. Female sex workers had the highest 6-month continuation rate (13.7%), while transgender individuals had the lowest (3.5%; adjusted OR (aOR) 0.37 (0.24\u20130.55), compared with female sex workers). The continuation rate generally increased with age; the oldest clients (\u226540 years) had a significantly higher continuation rate than those aged 18\u201324 (12.9% vs 11.0%; aOR 1.15 (1.02\u20131.29)). Unemployment was also associated with a small but significant reduction in continuation, with a rate of 11.8% for unemployed clients compared with 12.1% for employed clients (aOR 0.86 (0.79\u20130.94)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings highlight the need for targeted interventions to improve PrEP continuation among KPs in Nigeria, particularly for younger clients and transgender people.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-018739","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:00:14Z","timestamp":1766142014000},"page":"e018739","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Oral PrEP continuation rates among key populations in Nigeria: a retrospective cohort study of a large-scale HIV prevention programme"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3245-4109","authenticated-orcid":false,"given":"Kene David","family":"Nwosu","sequence":"first","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abiye","family":"Kalaiwo","sequence":"additional","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"},{"name":"Office of HIV\/AIDS and TB, US Agency for International Development, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wingston","family":"Ng\u2019ambi","sequence":"additional","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"},{"name":"Department of Health Systems, Kamuzu University of Health Sciences, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omosalewa","family":"Oyelaran","sequence":"additional","affiliation":[{"name":"Office of HIV\/AIDS and TB, US Agency for International Development, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Umoh","sequence":"additional","affiliation":[{"name":"Heartland Alliance Nigeria, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janne","family":"Estill","sequence":"additional","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Keiser","sequence":"additional","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"2025121903200671000_10.12.e018739.1","doi-asserted-by":"crossref","first-page":"e502","DOI":"10.1016\/S2352-3018(21)00127-2","article-title":"Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study","volume":"8","author":"Schaefer","year":"2021","journal-title":"Lancet HIV"},{"key":"2025121903200671000_10.12.e018739.2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0140-6736(15)00056-2","article-title":"Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial","volume":"387","author":"McCormack","year":"2016","journal-title":"The Lancet"},{"key":"2025121903200671000_10.12.e018739.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"2025121903200671000_10.12.e018739.4","doi-asserted-by":"crossref","first-page":"e402","DOI":"10.1016\/S2352-3018(17)30089-9","article-title":"Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study","volume":"4","author":"Molina","year":"2017","journal-title":"Lancet HIV"},{"key":"2025121903200671000_10.12.e018739.5","unstructured":"Lyons SJ , Johnson AS , Hu X , et al . Monitoring selected national hiv prevention and care objectives by using HIV surveillance data: united states and 6 dependent areas, 2020. National Center for HIV\/AIDS, Viral Hepatitis, STD,; TB Prevention (U.S.). Division of HIV\/AIDS Prevention; 2022."},{"key":"2025121903200671000_10.12.e018739.6","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1016\/S2352-3018(22)00030-3","article-title":"Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis","volume":"9","author":"Zhang","year":"2022","journal-title":"Lancet HIV"},{"key":"2025121903200671000_10.12.e018739.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0228620","article-title":"Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa","volume":"15","author":"Pillay","year":"2020","journal-title":"PLoS One"},{"key":"2025121903200671000_10.12.e018739.8","unstructured":"UNAIDS . Nigeria. 2024. Available: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/nigeria"},{"key":"2025121903200671000_10.12.e018739.9","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2023.102098","article-title":"Estimation of HIV prevalence and burden in Nigeria: a Bayesian predictive modelling study","volume":"62","author":"Onovo","year":"2023","journal-title":"EClinicalMedicine"},{"key":"2025121903200671000_10.12.e018739.10","unstructured":"Federal Ministry of Health . HIV\/STI integrated biological and behavioural surveillance survey (IBBSS). Federal Secretariat Complex, Phase III, Ahmadu Bello Way, Central Business District, Abuja, Nigeria Federal Ministry of Health, Nigeria; 2021."},{"key":"2025121903200671000_10.12.e018739.11","unstructured":"National Agency for the Control of AIDS (Nigeria) . National HIV self-testing and pre-exposure prophylaxis communication strategy 2022. 2022. 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