Preliminary effect of mHealth intervention on PrEP engagement among female sex workers in Dar es Salaam, Tanzania

Background: Female sex workers are among groups at increased risk of HIV infection. In Tanzania, HIV prevalence among FSW is more than twice as high as other women in the general population. Pre-exposure prophylaxis (PrEP) has been proven to be effective in preventing HIV transmission, but low retention to services poses a challenge to its effectiveness. Innovative interventions to tackle the problem and help achieve universal health coverage goals are called for. Objective: To determine the preliminary effect of mHealth application on PrEP services engagement among female sex workers in Dar es Salaam. Methods: Using respondent driven sampling, 470 female sex workers eligible for PrEP and who owned a smartphone were recruited. All participants were provided with a smartphone-based mHealth app (Jichunge app) designed to promote PrEP use and retention among HIV at risk population. We utilized information collected during the baseline, follow-up, and data on the use of Jichunge app for a period of 30 days. The effect of Jichunge intervention on PrEP services engagement was assessed using generalized Poisson regression model. Results: Of 470 recruited participants, 253 (53.8%) were engaged in PrEP services in 6 months following the initiation of PrEP. Engagement in PrEP services was significantly higher among those who opened the Jichunge app after installation (APR=1.4, 95% CI: 1.13-1.85), used gamification functions (APR=1.5, 95% CI: 1.18-1.89), visited PrEP editorial contents (APR=1.4, 95% CI:1.16-1.67), consulted a doctor or peer educator (APR=1.5, 95% CI:1.29-1.79), or engaged in the discussion with other PrEP users (APR=1.4, 95% CI:1.17-1.62). Conclusion: The use of Jichunge mHealth application significantly increased PrEP services engagement among female sex workers in Dar es Salaam. The results indicate that use of mHealth interventions hold potential to promote universal health coverage in a cascade of PrEP and other related interventions. Recommendations: mHealth interventions should be incorporated in implementation of the PrEP roll-out to promote utilization of PrEP services among the targeted populations. Studies that compare between intervention and control, as well as specific PrEP cascade such as retention in clinical care and adherence to PrEP are needed for further evidence.