HIV pre-exposure prophylaxis utilization among key populations in delta state, Nigeria: patterns, accessibility, and barriers

Background: Pre-exposure prophylaxis (PrEP) is an important biomedical option for HIV prevention among key populations, but its effectiveness depends on use during periods of HIV exposure. This study assessed self-reported current PrEP use, service accessibility, and perceived barriers among key populations in Delta State, Nigeria. Methods: A facility- and community-based cross-sectional survey enrolled 602 key population members aged 18 years and older, including female sex workers, men who have sex with men, people who inject drugs, and transgender persons. Participants were recruited through hotspot-based purposive sampling and peer referral. Data were collected using an interviewer-administered questionnaire and analyzed with descriptive statistics, chi-square or Fisher’s exact tests, and multivariable binary logistic regression at a 5% level of significance. Current PrEP use, compared with discontinued use, was the study outcome. Results: Current PrEP use was reported by 505 (83.9%) respondents, while 97 (16.1%) had discontinued use. Awareness of PrEP/HIV prevention information was reported by 553 (91.9%), no PrEP stock-outs by 470 (78.1%), and easy access to PrEP service providers by 469/554 (84.7%). Side-effect concern was the most commonly reported barrier, 312 (51.8%), followed by stigma, 204 (33.9%); all 13 respondents reporting misconceptions had discontinued PrEP use. Current PrEP use was significantly associated with awareness of PrEP/HIV prevention information, source and outlet of PrEP services, reported stock-outs, availability of PrEP where respondents lived, and access to PrEP providers. Sex, key population type, educational level, marital status, and monthly income were also significantly associated with current PrEP use (all p<0.05). In adjusted analysis (n=578), local PrEP availability was associated with higher odds of current use (AOR=10.15, 95% CI: 5.26–19.58), whereas female sex work (AOR=0.17, 95% CI: 0.08–0.34), age ≥26 years (AOR=0.31, 95% CI: 0.18–0.55), any monthly income (AOR=0.06, 95% CI: 0.03–0.12), and reported absence of stock-outs (AOR=0.36, 95% CI: 0.17–0.79) were inversely associated with current use. Conclusion: Current PrEP use was high among participants, but access to services and misconceptions were important correlates. The findings suggest that geographically accessible, confidential, and differentiated PrEP services, with counseling on side effects, stigma, and misinformation, may support continued use.