BACKGROUND: With an annual HIV incidence rate of 47%, over 56% of the female sex workers in Zambia are living with HIV (UNAIDS, 2020). However, the uptake of pre-exposure prophylaxis among FSWs in the Zambia-Zimbabwe border town of Chirundu remains low at 22% of those that test negative.
DESCRIPTION: Between December 2022 and January, 2023, USAID CHEKUP implemented by John Snow Health Zambia, embarked on an initiative to orient and then engage FSWs already accessing PrEP to identify peers in their network, provide PrEP messaging and facilitate them to take up PrEP. In a snow ball approach, 5 trained health care workers, trained a pool of 15 community health workers on how to provide orientation around PrEP messaging to 75 FSWs who were mostly (75%) aged 20-24 years. FSWs in turn delivered these PrEP promotion messages alongside sharing their lived experiences around the benefits of PrEP, addressed the misgivings, and facilitated linkage to PrEP.
LESSONS LEARNED: Over a three week period, the 75 FSWs reached out to 284 of their peers among which 43 (15.1%) were discovered to be positive and already on treatment, 61 (21.5%) were newly identified positives and were linked for antiretroviral therapy. From the remaining 180 HIV negative FSWs, 164 (91.1%) were initiated on PrEP, while the rest (16) (8.9%) indicated that they needed to think about it, or the time was not appropriate and that they could commence at a later date. The majority (52%) of the FSWs that took up PrEP were in the same age band (20-24 years old) as their PrEP promoting peers. Being spoken to by someone who is in my situation and also taking the medicine (85%) and them making it convenient for me to access the medicine (71%) were the prominent reasons given by the new recipients for then to be initiated on PrEP.
CONCLUSIONS: With the PrEP uptake under the peer to peer modality being significantly higher than the routine approach (91.1% vs. 22%), the peer to peer model has potential to increase both acceptability and uptake of PrEP among FSWs particularly for programs recording low PrEP usage among FSWs.