Women engaging in sex work (WESW) in low- and middle-income countries face a disproportionately high risk of HIV infection. This study explores enablers and barriers to the uptake and persistence of oral pre-exposure prophylaxis (PrEP) and long-acting injectable PrEP (LAI-PrEP) among WESW in Lusaka, Zambia. We evaluated Capability, Opportunity, and Motivation behavioral domains, using the COM-B model, which affectied behavioral engagement with PrEP services among newly-initiated WESW from community-based safe spaces. Participants were recruited from July-October 2023 and interviewed using a semi-structured guide to explore barriers and enablers to engagement with HIV prevention. We used a rapid analysis approach-a two-step qualitative method-to identify themes aligned with COM-B domains. Interviews were conducted in English, ChiNyanja, or IchiBemba, audio-recorded, translated into English when necessary, and transcribed verbatim. Among 18 participants with a median age of 28 years (IQR:23-33) and 5 years in sex work (IQR:2,7), education during outreach by peer navigators and program staff was crucial to building trust and demystifying PrEP. Persistent knowledge gaps and misconceptions, especially about daily adherence and alcohol use, were significant barriers. Trustworthy program staff and reliable service provision facilitated continued PrEP use, and women preferring that drugs be delivered to them. Social support systems were mixed, offering both aid and competition. Personal empowerment and health protection motivated PrEP use, with LAI-PrEP preferred for eliminating daily pill burdens and associated stigma. However, inconsistent supply and misconceptions about LAI-PrEP were potential barriers. This study underscores the importance of person-centered care in addressing the complex interplay of individual, community, and programmatic factors influencing PrEP engagement among WESW in Zambia. A holistic focus, and adaptive health service delivery approach are both crucial to ensure that advances in HIV prevention translate into tangible benefits for WESW. Reliable, respectful healthcare programs that provide accurate, and trusted information are essential for improving PrEP uptake and persistence.

Copyright: © 2025 Kumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

在低收入和中等收入国家从事性工作的女性面临感染艾滋病毒的高风险。本研究探讨了赞比亚卢萨卡地区从事性工作的女性（WESW）在接受口服暴露前预防药物（PrEP）以及长效注射型PrEP（LAI-PrEP）方面的促进因素和障碍。我们使用COM-B模型评估能力、机会和动机行为领域，这些领域影响新发起的WESW在社区基底安全空间中参与PrEP服务的行为。参与者于2023年7月至10月期间招募，并通过半结构化访谈探讨了与艾滋病毒预防相关的障碍和促进因素。我们使用了一种快速分析方法——一种两步质性研究方法，以识别与COM-B领域相符合的主题。访谈用英语、齐尼亚anja语或伊奇贝姆巴语进行，必要时录音并翻译成英文，并逐字转录。在18名参与者中（中位年龄28岁，四分位距23-33；从事性工作5年，四分位距2-7），同伴导航员和项目工作人员的外展教育对于建立信任和澄清PrEP至关重要。持续的知识差距和误解，特别是关于每日服药和饮酒的问题，是重要的障碍。可信赖的项目人员和服务提供者的可靠性有助于继续使用PrEP，并且女性更倾向于药物送到她们手中。社会支持系统好坏参半，既有帮助也有竞争。个人赋权和健康保护动机促使了PrEP的使用，而LAI-PrEP由于消除了每日服药负担及相关污名而被优先考虑。然而，不稳定的供应以及对LAI-PrEP的误解可能是潜在障碍。这项研究强调了针对赞比亚WESW群体中影响PrEP参与度的个体、社区和项目因素之间的复杂互动，个人中心护理的重要性。整体关注和适应性健康服务递送方法对于确保艾滋病毒预防进展转化为切实利益至关重要。可靠且尊重的医疗保健计划提供准确可信的信息是提高PrEP采用率和持续性的关键要素。