African Journal of Public Health and Health Systems | 15 October 2016
A Systematic Review of Community-Based Peer Network Delivery Models for Pre-Exposure Prophylaxis (PrEP) Uptake and Adherence Among Female Sex Workers in Mombasa, Kenya
W, a, n, j, i, k, u, M, w, a, n, g, i, ,, A, m, i, n, a, J, u, m, a
Abstract
Female sex workers in Mombasa, Kenya, are disproportionately affected by HIV. While pre-exposure prophylaxis is an effective prevention tool, its implementation among this group faces barriers. Community-based peer network models have been suggested to improve PrEP delivery. This systematic review aimed to synthesise evidence on the effectiveness, acceptability, and operational characteristics of community-based peer network models for PrEP service delivery, focusing on PrEP uptake and adherence among female sex workers in Mombasa. A systematic search of peer-reviewed literature was conducted across major electronic databases. Included studies reported on PrEP interventions delivered through peer networks for female sex workers in Mombasa. Data extraction followed a standardised protocol, study quality was assessed, and a narrative synthesis was performed. Five studies met the inclusion criteria. Peer-led models were highly acceptable and effectively increased initial PrEP uptake. However, sustaining high adherence beyond six months remained a significant challenge. Reported barriers included mobility, side-effects, and fluctuating HIV risk perception. Peers were crucial for providing psychosocial support and mitigating healthcare system stigma. Community-based peer networks are a feasible and effective model for initiating PrEP among female sex workers in Mombasa. The model is less effective at ensuring long-term adherence without additional supportive structures. Programmes should integrate peer networks with strengthened clinic-community linkages and tailored adherence support. Future implementation research should focus on strategies to sustain adherence and explore the cost-effectiveness of these integrated models. Pre-exposure prophylaxis, HIV prevention, female sex workers, peer networks, community-based, adherence, Kenya. This review consolidates existing evidence on peer-led PrEP delivery for a key population in a high-prevalence setting, informing the design of more effective and sustainable HIV prevention programmes.