Title: HIV pre-exposure prophylaxis adherence among female sex workers in Mutare urban, Zimbabwe Emillia Mutya 1 , Dr Maxwell Mhlanga 2 Corresponding author: Dr Maxwell Mhlanga, University of Zimbabwe, Faculty of Medicine and Health Science, P.O. Box A178 Avondale Harare, profmaxmhlanga7@gmail.com Emillia Mutya: Africa University College of Health Sciences, Agriculture and Natural sciences, P.O. Box 1320, Mutare. emillia.mutya@plan-international.org Abstract Pre-exposure prophylaxis (PrEP) for HIV is a strategy that has been recently engineered to prevent individuals who are human immunodeficiency virus (HIV)-negative but are at high risk of being infected with HIV. Sex workers are one of the vulnerable groups that are targeted by PrEP, however effectiveness of PrEP is realised when there is maximum adherence. Empirical evidence from Mutare Urban district revealed that for the period April to November 2019, the adherence rate was 22 % (NAC, 2019).Therefore, this study sought to unearth the reasons why sex workers were not adhering to PrEP. A 1:1 unmatched case- control study was carried out in Mutare urban. The source population of this study was all female sex workers registered under NAC key population programs in two sites namely Forbes and Sakubva residing in Mutare urban. A total sample size of 64 participants calculated using Epi info 7 was used for this study. Participants were identified from records at the study sites and systematic sampling was done for both controls and cases. Proportional selection of participants was done for the two centres. Data was collected using an interviewer administered structured questionnaire and a key informant interview guide was used to interview health service providers. Data was analysed using Epi info version 7. A multivariate analysis showed age [AOR = 2.14, 95% CI (1.08 – 3.34)], household expenditure per month [AOR = 18.77, 95% CI (3.13 – 11.21)], consistent use of condoms [AOR = 11.78, 95% CI (1.03 – 13.41)], alcohol use [AOR = 2.55, 95% CI (1.01 –5.32)], experienced side effects [AOR = 16.06, 95% CI (5.71 – 22.56)] and satisfaction with health service provision [AOR = 10.01, 95% CI (2.32 – 43.25)] to be statistically significant predictors of uptake of PrEP services. There is need for tailor made interventions for young sex workers, furthermore use of mobile applications to remind clients, provision of safety nets and continued health education to both the female sex workers and the community at large to reduce stigmatization. Key Words: Pre-exposure prophylaxis, adherence Introduction The leading cause of global morbidity and mortality is Acquired Immune-Deficiency Syndrome (AIDS) and 36.7 million people are living with Human Immuno-deficiency Virus (HIV). Annually an average of 1.1 million people die from HIV and AIDS. The last 15 years has seen tremendous progress being made against AIDS and this has led to a global commitment to end the epidemic by 2030 1 . One of the prevention intervention methods that was recommended by the World Health Organisation (WHO) in September 2015 was the offering of oral pre-exposure prophylaxis (PrEP) as part of combination HIV prevention approaches for people at substantial risk of HIV infection. Substantial risk was found to be more in the key populations’ and these include sex workers, people who inject drugs, transgender people, prisoners, gay men and other men who have sex with men. Sex workers are 10 times more likely to acquire HIV. Globally, key populations and their sexual partners accounted for 36% of the new HIV infections in 2015 1 . HIV PrEP prevents individuals who are human immunodeficiency virus (HIV)-negative but are at high risk from being infected by HIV. PrEP currently involves the use of two coformulated antiretroviral drugs, teno-fovir disoproxil fumarate and emtricitabine (TDF/FTC; brand name Truvada), taken as a combined oral tablet by HIV- negative people to reduce the risk of HIV infection 2 . Randomized clinical trials of PrEP for HIV prevention have widely divergent efficacy estimates, ranging from 0% to 75% and studies have attributed this to different factors with adherence being the most cited deterrent 3 . Globally, there has been a general high acceptability of PrEP among different targeted population groups including female sex workers (FSWs) yet there is a steady increasing trend of PrEP defaulting in Low to Medium Income Countries (LMICs) including Zimbabwe. Currently, PrEP is being supplied on a monthly basis in Mutare urban sites and according to the Centre for Sexual Health and HIV/AIDS Research Zimbabwe IN 2019, a person is classified a defaulter when they have missed one clinical appointment. In Zimbabwe, female sex workers constitute one of the most vulnerable sub-groups to HIV who have embraced PrEP, however empirical evidence provided by the National Aids Council (NAC) for Mutare urban district has revealed that for the period April to November 2019, the adherence rate is 22 % 4 . Information regarding the reasons to this high defaulter rate is not IJRDO - Journal Of Health Sciences And Nursing ISSN: 2456-298X Volume-6 | Issue-2 | Feb, 2021 31