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

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.