Beyond the pill: contextual effects of community-based PrEP delivery on pregnancy risk among FSWs in Cameroon – a propensity score-matched analysis

Female sex workers (FSWs) face elevated risks of both HIV acquisition and unintended pregnancies. While oral pre-exposure prophylaxis (PrEP) is an established HIV prevention tool, its broader impact on sexual and reproductive health (SRH) outcomes remains unclear in real-world settings. In Cameroon, PrEP is delivered via community-based platforms where SRH services are opportunistically offered alongside HIV prevention. To assess how exposure to an integrated, community-based oral PrEP–SRH programme influences the occurrence of pregnancy among FSWs in Cameroon. We conducted a cross-sectional analysis using propensity score–matched data from FSWs enrolled in a national PrEP programme. Age was centred at the median (24 years), and robust Poisson regression models were fitted to estimate adjusted risk ratios (aRRs) for pregnancy occurrence. An interaction term between age and PrEP exposure was introduced, and model stability was assessed via bootstrap resampling (1,000 iterations). Pregnancy occurred in 28.4% of FSWs not on PrEP compared with 20.5% among PrEP users. No significant association was observed in unstratified models (aRR = 0.82; 95% CI: 0.44–1.52; p = 0.522). A significant interaction with age was detected (aRR = 1.38; 95% CI: 1.05–1.82; p = 0.021), but bootstrap validation showed that the 95% confidence interval for the regression coefficient (B = 0.323; 95% CI: − 0.083 to 0.610; p = 0.024) included the null, raising concerns about robustness. Community-based delivery of PrEP within integrated SRH platforms showed no overall association with pregnancy occurrence among FSWs, although a possible age-related effect was suggested. These findings underline the importance of delivery context and highlight the need for larger, prospective studies to confirm whether integrated models can influence reproductive outcomes and inform the development of future multipurpose prevention technologies (MPTs).