Key factors influencing the adoption of HIV pre-exposure prophylaxis (PrEP) among commercial sex workers in Nekemte Town, Western Ethiopia, 2023

The rate of HIV among female sex workers in Ethiopia ranges from 14% to 28%, significantly surpassing the adult prevalence rate in the country, which stands at only 0.9%. Female sex workers must adopt pre-exposure prophylaxis (PrEP) due to their heightened vulnerability to HIV, attributed to factors such as inconsistent condom use and frequent encounters with multiple sexual partners. PrEP serves as an essential biological prevention strategy that effectively reduces the likelihood of HIV infection when taken consistently. Beyond safeguarding their own health, enhancing the uptake of PrEP among female sex workers is vital for comprehensive HIV prevention initiatives, as it contributes to a decrease in overall HIV transmission within the community. A facility-based cross-sectional study was done on 422 HIV-negative female sex workers (FSWs) attending HIV negative female sex workers aged 18 years and above at key population friendly clinics in Nekemte town from January 15 to February 28, 2023. Participants were selected using systematic random sampling from client registration lists in two key population-friendly facilities. A pre-tested interviewer-administered questionnaire was utilized to collect data related to the study objectives. Data were entered into Epi Data version 4.1 and exported to SPSS version 24 statistical software for analysis. Binary logistic regression analysis was used to see the association between independent and response variables. P < 0.05 was used to declare the statistical significance. PrEP uptake among female commercial sex workers in Nekemte town was found to be 43.30% [38.6%, 48.1%]. PrEP use was significantly associated with age greater than 24 years (AOR = 2.03; 95%CI: 1.21, 3.38), awareness of PrEP (AOR = 2.53, 95%CI: 1.61, 3.98), HIV risk perception (AOR = 1.89, 95%CI: 1.20, 2.94), and having flexible working hours for service (AOR = 2.89, 95%CI: 1.85, 4.53). The study indicates a need to increase awareness of PrEP and provide better support for younger female sex workers, improve educational efforts, foster a correct understanding of HIV risk, and offer more flexible service hours. Nevertheless, no notable association were identified between the use of PrEP and factors such as substance abuse, condom usage, religious beliefs, or attitudes toward HIV, which might be attributed to variations in population characteristics and differences in healthcare systems.