Feasibility and Acceptability of Delivering HIV Self‐Testing and Oral PrEP Refills to Female Sex Workers Through Community Drug Shops in Kampala, Uganda: A Single‐Arm Pilot Interventional Study
Catherine Nakaye, Denis Mawanda, Nelson Mukiza, Brenda Gati Mirembe, Rita Nakalega, Zubair Lukyamuzi, Hajira Kataike, Josephine Basirika, Clemensia Nakabiito, Mary Glenn Fowler, Renee HeffronABSTRACT
Introduction
Female sex workers (FSWs) in Uganda are disproportionately affected by HIV, with prevalence estimates reaching 37%. Decentralization of pre‐exposure prophylaxis (PrEP) delivery, including community‐based mechanisms, brings services closer to target populations. We assessed feasibility and acceptability of decentralized oral PrEP refill delivery with HIV self‐testing (HIVST) through a drug shop‐based model in Kampala, Uganda, among FSWs already using oral PrEP.
Methods
From October 2024 to June 2025, we conducted a single‐arm pilot interventional study with 45 FSWs, aged≥18 years, receiving oral PrEP from a government facility for ≥ 1 month before enrolment. Participants were purposively linked to community drug shops convenient to their areas of residence for oral PrEP refills provision after HIVST at 1, 3 and 6 months. Feasibility was assessed by study participation rate, accrual and retention parameters. Structured questions using a 4‐point Likert scale were used to collect acceptability data at 3 and 6 months. Persistence was assessed by measuring proportions of participants who continued in care, received HIVST and oral PrEP refills from community drug shops. Descriptive analysis was conducted to summarize feasibility, acceptability and persistence to PrEP refills.
Results
A total of 45 FSWs (median age [IQR]: 29 [26–35] years) were enrolled. All participants (100%, 45/45) willingly took up the community drug shop–based PrEP delivery model at baseline. Participant retention was 95.6%, 100% and 95.6% at 1, 3 and 6 months, respectively, which aligned with PrEP refill rates. Over 95% of FSWs at 3 and 6 months visits felt very comfortable and preferred receiving PrEP refills from community drug shops, with 100% of participants acknowledging them as very accessible, offering very private service and comfort to discuss sexual health with attending staff. HIVST convenient usability for drug shop staff possibly contributed to model acceptability.
Conclusions
Community drug shop–based HIVST and oral PrEP refill delivery was feasible, acceptable and demonstrated high persistence with oral PrEP refills among this small FSW cohort in Uganda. These results warrant further research to evaluate the oral PrEP refill decentralization impact of this model when it is scaled up to reach a larger number of FSWs and other population groups.