Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Adherence Among Female Sex Workers in Urban Tanzania: A Descriptive Qualitative Study

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Published Jul 28, 2026
DOI https://doi.org/10.24248/eahrj.v10i1.873

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Edith A.M Tarimo
Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Masunga K Iseselo
Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Joel S Ambikile
Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Gift Lukumay
Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Patricia Munseri
dDepartment of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;
Muhammad Bakari
dDepartment of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;
Eligius Lyamuya
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;
Said Aboud
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; National Institute of Medical Research, Dar es Salaam, Tanzania;
Rachel Kawuma
National Institute of Medical Research, Dar es Salaam, Tanzania;
Janet Seeley
gMRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda and Department of Social Science Unit; hAfrica Health Research Institute, KwaZulu-Natal, Durban, South Africa; iLondon School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, United Kingdom.

Abstract

Background: Oral pre-exposure prophylaxis (PrEP) is an established biomedical intervention for HIV prevention. Despite
the availability of PrEP, female sex workers (FSW) remain disproportionately affected by HIV. This study explored the
facilitators and barriers to PrEP adherence among the FSW participating in an HIV vaccine trial in Tanzania.
Methods: We conducted a descriptive, qualitative study nested within a multicentre, Phase IIb, three-arm, two-stage HIV
prophylactic vaccine trial with a second randomisation to compare two pre-exposure prophylaxis regimens (PrEPVacc
trial). We present findings from the Dar es Salaam site in Tanzania. Between 2021 and 2023, we conducted 15 in
depth interviews (IDIs) at three points and four focus group discussions (FGDs) among FSW enrolled in the HIV vaccine
trial. Data were analysed manually using framework and thematic content analysis approaches.
Results: Facilitators for PrEP adherence included perceived benefits of PrEP, manageable side effects, use of reminders,
establishing a friendly schedule for taking PrEP, the possibility of engaging in unprotected sex with clients whose HIV
status is unknown, concealing PrEP by taking it privately, linkage to trial participation, and a clear understanding of
the clinical protocol requirements. Barriers included the use of distinctive PrEP packaging, being away from home or
travelling without the pills, concerns about retaining clients for sex work while using PrEP, anxiety related to HIV stigma,
forgetfulness, and experiencing hunger.
Conclusion and recommendations: Both trial-related and individual-related factors affected PrEP adherence among the
FSW participating in the PrEPVacc trial. Trial participation, perceived benefits, manageable side effects, and personal
motivation supported adherence to PrEP, while stigma reduced consistent use. Tailored education and stigma-reduction
strategies are necessary to enhance PrEP adherence among the FSW.

Article Details

Issue
Vol 10 No 1 (2026): East African Health Research Journal
Section
Original Articles