# Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Joseph Larmarange, Mélanie Plazy, Marcellin Nouaman, Evelyne Kissi, Rose-Marcelle Dedocoton, Patrick Coffie, Serge Eholié, Valentine Becquet

► To cite this version:

Joseph Larmarange, Mélanie Plazy, Marcellin Nouaman, Evelyne Kissi, Rose-Marcelle Dedocoton, et al. Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters. IAS 2025, the 13th IAS Conference on HIV Science, International AIDS Society, Jul 2025, Kigali, Rwanda. **hal-05163730**

HAL Id: hal-05163730

https://hal.science/hal-05163730v1

Submitted on 15 Jul 2025

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Distributed under a Creative Commons Attribution 4.0 International License
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Source: PRINCESSE project

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IAS 2025
13–17 July

**IAS 2025 · Kigali · 15th July 2025**

# Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

**Joseph Larmarange**, Mélanie Plazy, Marcellin Nouaman, Evelyne Kissi, Rose-Marcelle Dedocoton, Patrick A Coffie, Serge Eholié, Valentine Becquet
# The ANRS 12381 PRINCESSE cohort

## Single-arm open cohort

* November 2019 → June 2023

* 489 Female Sex Workers (18+) enrolled

* HIV- or HIV+, HBsAg- or HBsAg+

* San Pedro region, Côte d'Ivoire

## Mobile clinics

* 10 prostitution sites (5 urban + 5 rural) visited every two weeks

* operated by Aprosam (community-based NGO)

## Comprehensive sexual health package

* including daily oral PrEP for HIV-/HBsAg-

* 3-monthly follow-up

* free HIV and hepatitis B care, STI screening and treatment, family planning and other services

<figure><img src="image_5.png" /><figcaption>PRINCESSE mobile clinic on a prostitution site</figcaption></figure>
<figure><img src="image_6.png" /></figure>

## Objective

* to describe PrEP cascade, follow-up, and PrEP trajectories within PRINCESSE

* to identify factors associated with PrEP early adoption

## Included population: 400 FSWs

* eligible for PrEP (HIV-, HBsAg- at baseline)

* enrolled up to December 2022 (i.e. at least 6 months before cohort closure)

## Collected data

* clinical forms, biological samples, socio-behavioral questionnaires, interviews
# PrEP cascade: methodological choices do matter

* Overall (not considering time)

* 98% ever interested

* 62% ever initiated

* 38% renewed PrEP at least once

<figure><img src="image_7.png" /></figure>

* Taking time into account

* 96% expressed interest within 4 (1+3) months after inclusion

* 51% initiated within 3.5 (0.5+3) months after inclusion

* 23.5% renewed within 4/5/6 months after initiation

<figure><img src="image_8.png" /></figure>
## 4 follow-up profiles

**very short** • **47.8%** (n=191)
(<6 months of follow-up)

**short** • **15.3%** (n=61)
(6-12 months of follow-up)

**seasonal** • **30.5%** (n=122)
(>12 months, but at least once a 6 months gap between 2 visits)

**regular** • **6.5%** (n=26)
(>12 months, no gap)

<figure><img src="image_9.png" /></figure>

Crédits : projet PRINCESSE
# PrEP status over time per follow-up profile

## 4 follow-up profiles

* **very short** (n=191)
  (<6 months of follow-up)

* **short** (n=61)
  (6-12 months of follow-up)

* **seasonal** (n=122)
  (>12 months,
  but at least once a 6 months
  gap between 2 visits)

* **regular** (n=26)
  (>12 months, no gap)

### PrEP status

<figure><img src="image_10.png" /></figure>

<figure><img src="image_11.png" /></figure>

Time since inclusion
4 types of PrEP trajectories

<figure><img src="image_12.png" /></figure>

never initiated PrEP

<figure><img src="image_13.png" /></figure>

initiated and later not interested anymore

<figure><img src="image_14.png" /></figure>

re-initiated after non-interest

<figure><img src="image_15.png" /></figure>

initiated and never expressed non-interest

<figure><img src="image_16.png" /></figure>

Follow-up profile
## 4 types of PrEP trajectories

<figure><img src="image_17.png" /></figure>

- never initiated PrEP

- initiated and later not interested anymore

- re-initiated after non-interest

- initiated and never expressed non-interest

## Emergence of a group of early adopters

among seasonal / regular follow-up

46% (68/148) of seasonal / regular

<figure><img src="image_18.png" /><figcaption>Follow-up profile</figcaption></figure>

seasonal

regular
# Complex individual PrEP trajectories of early adopters

## It's not "perfect"

* periods of temporary exits (light red)

* reinitiation after non-interest (non-interest in yellow)

* some PrEP discontinuation between 2 follow-up visits (dark green)

* TDF dosage (dark points): only 3/24 (12,5%) with tenofovir being detected

*Each row represents an individual trajectory.*

<figure><img src="image_19.png" /></figure>

Tenofivir dosage ▲ detected • not detected
# Factors associated with being an early adopter

* among seasonal/regular follow-ups

* multivariable logistic regression, reduced model by AIC minimization

## PrEP early adoption associated with sex work precarity

* more frequent among those having the lowest price for sex work and

* among those working in a brothel (also less mobile)

### Usual price for sex work

<figure><img src="image_20.png" /></figure>

### Works in a brothel

<figure><img src="image_21.png" /></figure>

● p <= 0.05

● p > 0.05
Discussion

* In PRINCESSE, **loss-to-follow-up** and **seasonality of risks** limited PrEP adoption

* PrEP uptake and follow up was clearly not optimal, as observed in other contexts

* The "PrEP cascade" is imperfect to catch the complexity of PrEP trajectories

* FSWs who were more precarious and less mobile became early adopters of this new prevention tool.

* They could serve as potential ambassadors for promoting its uptake and demand creation.

Adopting a new tool needs time

* As expressed by a peer educator during the project restitution workshop: "We need time! 40 years ago, it took us 10 years to adopt massively condoms."

<figure><img src="image_22.png" /></figure>

Source: PRINCESSE project
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Thank you for your attention

Special thanks to

• PRINCESSE participants

• Aprosam team on the field

• PAC-CI team for coordination

• ANRS|MIE for funding

• all partners

and the 23 PRINCESSE babies!

Source: PRINCESSE project
<figure><img src="image_24.png" /></figure>

## Investigators-Coordinators

**PAC-CI, CI:** S Eholié

**Ceped, IRD, Université Paris Cité, Inserm, FR:** J Larmarange

## Study Team (alphabetical order)

**Aprosam, San Pedro, CI:** A Agoua, C Zebago, GH Zonhoulou Dao

**BPH, Univ. Bordeaux, Inserm, IRD, FR:** X Anglaret, F Dabis, M Plazy

**Ceped, IRD, Université Paris Cité, Inserm, FR:** V Becquet, P Biligha, J Larmarange

**CES, Université Paris 1, FR:** C Pougue Biyong

**Espace Confiance, Abidjan, CI:** C Anoma

**Harvard University, Boston, US:** K Freedberg, E Hyle, A Mohareb

**Hôpital Saint-Antoine, FR:** A Boyd, K Lacombe

**Ined, Paris, FR:** V Becquet, J Larmarange

**IPLESP, Sorbonne Université, Inserm, FR:** E Teyssou

**PAC-CI, Abidjan, CI:** X Anglaret, A Attia, MF Banga, P Coffie, C Danel, RM Dedocoton, S Eholié, E Kissi, JM Masumbuko, A Mian, R Moh, MN Nouaman

**SESSTIM, Univ. Aix-Marseille, Inserm, IRD, FR:** A Faye, M Fiorentino, B Spire

**Sorbonne Université, Pitié-Salpêtrière, FR:** V Calvez, A Jary, V Leducq, AG Marcelin

**Université de Bordeaux, CHU de Bordeaux, FR:** C Bébéar

**Université Paris Cité, AP-HP, FR:** B Berçot

## Internship students

**Ceped, IRD, Université Paris Cité, Inserm, FR:** H Juliard, J Littner

**ISPED, Université de Bordeaux, FR:** N Badirou, E Maouhoub, C Meertens, E Moreno, R Mouquin, H Youssoufa

## Implementation team

**Aprosam, San Pedro, CI:** A Agoua (medical investigator), P Amani (medical investigator), KP Anvo, S Akou, ML Brou, Cécé, Chef d'état major, Dodo, Flore, Francas, Kiki, L Kouakou, J Kouassi, P Kouassi, Mama Kate, Merveille, Miss Falone, Nemy, Roky, Sly, C Zebago (medical investigator), GH Zonhoulou Dao (medical investigator)

**CEDRES, Abidjan, CI:** E Koné-Bravo

**PAC-CI, Abidjan, CI:** MN Nouaman (project coordinator)

## Data management & monitoring

**PAC-CI/MEREVA, CI:** MN Nouaman, A Kouamé, S Lenaud, A Mian, C Yao

## Scientific Advisory Board

K Lacombe (chair, Hôpital Saint-Antoine, Paris), I Ahiba Bobo (National AIDS Programme, Abidjan), E Allah Kouadio (National Viral Hepatitis Programme, Abidjan), N de Castro (Hôpital Saint-Louis, Paris), A Horo (PAC-CI, Abidjan), C Laurent (IRD, Montpellier), J Tetty (Bletty, Abidjan), B Vuylsteke (Institut de Médecine Tropicale, Anvers), M Zannou (Université d'Abomey-Calavi, Cotonou)

## Study sponsor representatives

**ANRS | MIE, Paris, FR:** S Amador-Paz, M Ben Mechlia, V Doré, N Mercier, A Montoyo, C Rekacewicz

https://hal.science/ANRS_12381_PRINCESSE
SCAN ME

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Lessons learned
from the PRINCESSE project

(English and French subtitles available)