Stakeholder Perspectives on a Community-Based Peer-Led Biomedical HIV Prevention Intervention for Women Who Engage in Sex Work in Southwestern Uganda: Results from a Qualitative Study

HIV prevalence among Ugandan women who engage in sex work (WESW) is 31%, yet uptake of oral pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) is suboptimal due to multiple factors, including stigma and barriers to accessing healthcare. "Peer mentors" (peer leaders within WESW networks) could facilitate community-based delivery of biomedical HIV prevention products for WESW. We conducted formative research with key stakeholders to refine a potential community-based, peer mentor-led PrEP/PEP intervention. From July-August 2023, we conducted focus group discussions (FGDs) and key informant interviews (KIIs), informed by the Capability, Opportunity, Motivation and Behavior (COM-B) model. Interview guides explored determinants of PrEP/PEP use, acceptability of hypothesized intervention components (monthly PrEP/PEP counseling, HIV self-testing [HIVST], peer delivery of oral PrEP refills, phone/SMS hotline for peer support, rapid PEP access), and elicited ideas about additional intervention components. We recruited WESW, peer mentors, providers, and implementing partners in southwestern Uganda. FGD and KII transcripts were analyzed using a rapid qualitative analysis approach. We conducted four FGDs with WESW (N = 20) and peer mentors (N = 21) and nine KIIs with providers (N = 4) and implementing partners (N = 5). Most described substantial interest in a peer-led oral PrEP/PEP model for WESW. Community-based PrEP/PEP delivery with flexible hours and locations (e.g., bars, lodges) was suggested to address barriers to accessing health facilities. Peer mentors were perceived as trusted agents to increase PrEP/PEP awareness and deliver person-centered care for WESW, in partnership with clinicians. Participants emphasized the need for comprehensive and ongoing peer mentor training and supervision. Integrated PrEP/PEP and HIVST provision were also described as key intervention components to empower WESW and support differentiated service delivery. A peer-led oral PrEP/PEP delivery strategy could address key barriers to biomedical HIV prevention use among WESW in Uganda. Subsequent research is needed to test the impact of this approach on PrEP/PEP use among WESW.