Same-night PrEP in community care: The Nightcafé model for male and transgender sex workers

Despite high risk of HIV infection, uptake of pre-exposure prophylaxis (PrEP) remains limited among male and transgender sex workers (MSW and TSW), and data on tailored interventions to improve access are scarce. The Nightcafé programme addresses this gap by offering low-threshold PrEP provision in a community-centred setting. This study assessed the programme's uptake, clinical feasibility and subsequent engagement in PrEP care.

Eligible MSW and TSW visiting the Nightcafé, a social space for sex workers, were offered same-night oral PrEP after a non-reactive HIV rapid test. Follow-ups were scheduled at 4 weeks and then quarterly at Checkpoint Zurich. We described participants' HIV exposure, baseline clinical findings, same-night PrEP provision and participants' stated intention to initiate PrEP and attendance at follow-up care.

Between January 2022 and December 2023, 99 participants enrolled in the programme; 57 agreed to share their data for research. Participants demonstrated substantial clinical indications for PrEP: 77% (n = 44) reported inconsistent condom use with a median of 20 sexual partners in the previous 3 months. No baseline clinical findings requiring deferral of PrEP initiation were identified. All expressed intent to initiate PrEP. Among participants not already enrolled in PrEP programmes abroad, 80% (95% CI: 70%-87%, n = 70) completed at least one follow-up. No known subsequent HIV seroconversions occurred.

Community-based same-night PrEP provision was clinically feasible and resulted in high initial linkage to facility-based follow-up care among MSW and TSW. Longer-term follow-up and comparative studies are needed to determine whether this model improves sustained retention in PrEP care.