Self-care strategies that support PrEP adherence: a qualitative study with female sex workers in rural Uganda

The World Health Organization (WHO) recently released revised guidelines on self-care interventions for health and well-being, which, in 2022, included recommendations supporting equitable access to information about and availability of pre-exposure prophylaxis (PrEP) as a self-care strategy. Successful implementation of PrEP as an HIV prevention strategy extends beyond providing access to medication. It hinges on individuals adopting self-care strategies to ensure adherence to PrEP in their daily lives. This paper aims to explore self-care strategies that bolster adherence to oral PrEP among female sex workers in two rural Ugandan settings. Through in-depth interviews with 20 female sex workers residing in fishing communities or Trans-Africa highway towns, we used deductive thematic analysis to explore people-centred and health system-centred perspectives on women's PrEP-related self-care strategies. A people-centred perspective on self-care illustrated a range of self-care strategies to support PrEP adherence conducted by women individually (medication reminders; pairing PrEP with daily habits), and with support from others in familial and social networks (verbal reminders to take tablets; information sharing; shared clinic visits; shared pill-taking routines). A health system-centred perspective illustrated the importance of support from health services and professionals. Examples included information provision; NGO clinics as friendly, safe, non-judgemental spaces; PrEP distribution through home-based care outreach strategies; in-bulk PrEP provision for work-related travel periods; formal integration of female sex workers into the system as peer health workers. By considering both person-centred and health system-centred perspectives on self-care, we can pinpoint strategies for health systems to assist female sex workers and their communities in preventing the acquisition and transmission of HIV.