{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:01:48Z","timestamp":1788609708354,"version":"build-2803163510"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Pre-exposure prophylaxis (PrEP) prevention-effective adherence is of critical importance but challenging particularly among key populations where periods of high HIV risk are frequent. We assessed the use of PrEP with reference to periods of unprotected sex among female sex workers in the city of Tanga.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was part of the pragmatic quasi-experimental trial for HIV PrEP rollout in Tanzania involving a control cohort of 313 female sex workers aged \u226518\u2009years recruited by respondent-driven sampling and followed for 12\u2009months. PrEP use and periods of condomless or unprotected sex were assessed at the 6th and 12th month of follow-up. Prevention-effective adherence was defined as PrEP use of \u22652 pills\/week and \u22656 pills\/week for anal and vaginal condomless sex. Multivariable modified Poisson regression was conducted to determine factors influencing PrEP use (\u22652 pills\/week).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 59.2 and 45.9% of participants had unprotected anal and vaginal sex with a client, respectively. The prevention-effective adherence for anal sex ranged from 8.0% (months 6) to 10.0% (months 12) while that of vaginal sex was from 10.1% (month 6) to 3.8% (month 12). Participants who lived with friends were 25.5 times more likely to use \u22652 PrEP doses per week than those who lived alone (aPR\u2009=\u200925.5; 95%CI: 2.55\u2013255.42, <jats:italic>p<\/jats:italic>\u2009=\u20090.006). Compared to self-reporting poor health status, self-reporting good health status significantly increased the use of \u22652 PrEP doses per week (aPR\u2009=\u200917.4; 95%CI: 3.01\u2013101.02, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Refusing condomless sex with a steady partner increased the likelihood of using \u22652 PrEP doses per week than accepting condomless sex with a steady partner (aPR\u2009=\u200911.2; 95%CI: 1.55\u201380.48, <jats:italic>p<\/jats:italic>\u2009=\u20090.017). The prevalence of using \u22652 PrEP doses per week was less among participants accepting condomless sex at high pay than those who refused (aPR\u2009=\u20090.1; 95%CI: 0.03\u20130.26, <jats:italic>p<\/jats:italic>\u2009=\u20090.000).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Use of PrEP during periods of unprotected sex was rare among female sex workers. Living with friends, self-reporting good health status, and refusing condomless sex with steady partners were associated with increased use of \u22652 PrEP doses per week. However, accepting condomless sex for increased payment was associated with reduced use of \u22652 PrEP doses per week. This calls for an in-depth study to understand the perspectives and circumstances shaping poor adherence during periods of unprotected sex among female sex workers.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1405765","type":"journal-article","created":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T04:50:02Z","timestamp":1721105402000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["HIV pre-exposure prophylaxis use during periods of unprotected sex among female sex workers in Tanga city, Tanzania: a control arm analysis of the pragmatic quasi-experimental trial"],"prefix":"10.3389","volume":"12","author":[{"given":"Wigilya P.","family":"Mikomangwa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K\u00e5re","family":"Moen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elia J.","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmy","family":"Metta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M.","family":"Kibusi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melkizedeck T.","family":"Leshabari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Appolinary A. R.","family":"Kamuhabwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Kwesigabo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5089\/9798400215414.002","article-title":"United Republic of Tanzania HIV country profile 2022","volume":"2022","year":"2022","journal-title":"Glob HIV Program Heal Organ"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/S0140-6736(23)00877-2","article-title":"The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review","volume":"402","author":"Broyles","year":"2023","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1177\/2631831818822015","article-title":"Defining \u201chigh-risk sexual behavior\u201d in the context of substance use","volume":"1","author":"Chawla","year":"2019","journal-title":"J Psychosexual Heal"},{"key":"ref4","volume-title":"UNAIDS Global AIDS Update 2023","year":"2023"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1186\/s12889-022-14046-3","article-title":"Does the perception of HIV risk among female sex workers affect HIV prevention behavior? 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Tanzania","author":"Dutta","year":"2014"},{"key":"ref20","first-page":"1","year":"2018"},{"key":"ref21","first-page":"10","year":"2021","journal-title":"Implementation framework for pre-exposure prophylaxis of HIV in Tanzania mainland"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"698","DOI":"10.3390\/ijerph20010698","article-title":"Harmful alcohol use and associated socio-structural factors among female sex workers initiating HIV pre-exposure prophylaxis in Dar es Salaam, Tanzania","volume":"20","author":"Lichtwarck","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref23","volume-title":"Introduction to HIV\/AIDS and sexually transmitted infection surveillance: module 4: introduction to respondent-driven sampling","year":"2013"},{"key":"ref24","first-page":"292","volume-title":"Essential medical 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female sex workers in Ekurhuleni district, South Africa","volume":"40","author":"Sikhosana","year":"2021","journal-title":"Pan Afr Med J"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1080\/09540120500412824","article-title":"Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo","volume":"18","author":"Ntumbanzondo","year":"2006","journal-title":"AIDS Care"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e028508","DOI":"10.1136\/bmjopen-2018-028508","article-title":"Sexual health needs of female sex workers in C\u00f4te d\u2019Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention","volume":"10","author":"Becquet","year":"2020","journal-title":"BMJ Open"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1186\/s12889-022-12639-6","article-title":"Increased condom use among key populations using oral 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