Operational research is required to design delivery of pre-exposure prophylaxis (PrEP) and early antiretroviral treatment (early ART). This paper presents the primary analysis of the TAPS Demonstration Project, a demonstration project offering both interventions to female sex workers (FSWs) in two urban clinic sites in South Africa.
TAPS was a prospective, observational cohort study with two arms delivered in existing service settings: 1) PrEP for HIV-negative FSWs, and 2) early ART for HIV-positive FSWs. The main outcome was retention at 12 months. We also present uptake, adherence, key demographic characteristics, number of sero-conversions, virological failures and sexually transmitted infections (STIs), as well as changes in sexual behaviour among participants and cost of services.
Of the 947 FSWs seen in clinic, 692 were HIV tested. HIV prevalence was 49%. Among those returning to clinic after testing and confirmed clinical eligibility, 98% (219/224) and 94% (139/148) took up PrEP and early ART, respectively. Of those enrolled, 22% on PrEP and 60% on early ART were seen at 12 months. The majority of women were married or had a stead partner, worked in brothels, and were born in Zimbabwe. Little change was seen over time in consistent condom use or the number of sexual partners, with high levels of consistent condom use with clients and low use with main partners in both study arms. There were no seroconversions on PrEP and seven virological failures on early ART. Total cost of service delivery was approximately $126 for PrEP and $406 for early ART per person-year.
PrEP and early ART services can be implemented within FSWs routine services in high prevalence, urban settings, with good uptake for both PrEP and early ART. Retention can be challenging among FSWs on PrEP, but those remaining in care can be consistent in attendance and reported adherence. Costs of the TAPS programme were higher than previously published, however there is potential for cost reduction at scale. The TAPS demonstration project results provided the basis for the first government PrEP and early ART guidelines and the roll out of a national sex worker plan in South Africa.