Thesis:

Determinants of human immunodeficiency virus pre-exposure prophylaxis uptake among sex workers in Nakuru town Kenya

The Initiative for Strong, Empowered, HIV-Free, Mentored, and Safe Women includes PrEP as one of its primary initiatives. However, adoption of Pre exposure Prophylaxis has been delayed in Sub-Saharan Africa despite effectiveness evidenced in studies. Nakuru County has a high HIV burden, with a prevalence of 4.1%, according to a study by the county administration. Only 4% of Female sex workers and 2% of Male sex workers were taking PrEP in 2018. The study assessed determinants of HIV PrEP uptake and retention among sex workers in Nakuru town Kenya. Theory of planned behavior and the AIDS risk reduction model served as the study's theoretical framework. The study design was a cross-sectional, analytical investigation. It targeted all the sex workers in Nakuru town who were 18 years old and above. Stratified sampling technique was used to get the sex workers hotspots, snow balling sampling technique was adopted to recruit the study participants. The data was obtained from the respondents using questionnaires. Descriptive and inferential statistics were adopted to analyze quantitative data. Findings were presented in table and graphical formats, 55% had used PrEP while 45% indicated that they had not. Further, this study found that even among the respondents who had used PrEP, only 20% indicated to still be on PrEP. In this regard, the study concluded that PrEP uptake is low considering that the actual target should be 100%. Further the study concluded that PrEP retention was low as only 20% reported still be on PrEP, chi square test was used to establish whether socio demographic characteristics were associated with the adoption of PrEP by the respondents. All the tests returned a statistically significant difference test, with chi result for age being, X2 (3, N = 375) =18.4, p = 0.000 gender, X2 (1, N = 375) =17.24, p = 0.000 education X2 (2, N = 375) =53.4, p = 0.000, and marital status being X2 (2, N = 375) =16.3, p = 0.000. Duration in the trade was also positively correlated with use or non-use of PrEP, X2 (2, N = 375) =13.4, p = 0.002. Questions on Likert scale indicated a high level of awareness, concluding that respondents had acceptable level awareness. On factors associated with HIV PrEP uptake and retention among sex workers in Nakuru town. Analysis using multiple logistic regression indicated that there was a collective significant effect between the awareness, health system factors, socio economic individual factors and use of PrEP among sex workers. A further analysis showed that, put together, the four predictor variables explained 20.3% of variation on PrEP retention factors that influences the respondents taking PrEP. The study concluded that while use and none use PrEP can be explained by the four factors evaluated in this study, there is an array of factors that influence utilization of PrEP. The study also recommends that while the rate of awareness is high among the respondents, the Nakuru health department needs to continue promoting this as this is necessary to increase utilization.