HIV prevalence, risk factors for infection, use of prevention methods, and interventions among taxi drivers and commercial motorcyclists in sub-Saharan Africa: A scoping review

BackgroundTransport workers, particularly taxi drivers and commercial motorcyclists, comprise a population at high risk for HIV and account for nearly one-third of new HIV infections in sub-Saharan Africa (SSA). Furthermore, transport workers bridge HIV infections from high-risk populations to the general population. This scoping review aimed to map the available evidence around HIV prevalence, risk factors for HIV infection, use of HIV prevention methods, and HIV interventions among taxi drivers and commercial motorcyclists in SSA. MethodThis scoping review used the Arksey and OMalley framework. Published articles were retrieved from MEDLINE (via PubMed), CINAHL, African Index Medicus, Web of Science, Scopus, EMBASE, HINARI, and Google Scholar from inception to August 2024. Two authors screened the titles and abstracts of retrieved studies and examined the references of relevant articles for additional literature. Three authors independently extracted data from the included studies using a standard data extraction form. Data were analyzed using descriptive statistics and content analysis techniques. The themes were collated, and a descriptive summary of the findings was reported. ResultsThis review included 24 studies. The HIV prevalence was 2.02%-9.9% among commercial motorcyclists, and reached 33.4% in samples comprising both motorcyclists and taxi drivers. The high HIV infection rate was attributable to numerous behavioral (e.g., multiple sex partners), psychosocial (e.g., stigma), and sociodemographic (e.g., age, income) risk factors. However, there was suboptimal use of HIV prevention methods such as safe male circumcision (20.7%-64.9%) and condoms (26%-45.7%). The two HIV interventional studies were conducted among commercial motorcyclists. Despite HIV testing being an entry point for chronic care, we found no study reporting the HIV cascade for commercial motorcyclists or taxi drivers who were diagnosed with HIV, including the use of antiretroviral therapy, pre-exposure prophylaxis (PREP), and post- exposure prophylaxis. ConclusionsThe numerous research gaps highlight the need for longitudinal research on HIV incidence and predictors in this key population, especially the structural determinants of HIV infection. There is also a need for interventional and observational research on new models of HIV testing (e.g., HIV oral testing), antiretroviral-based HIV prevention methods (e.g., PREP), and the role of peer-to- peer educator or group support/counseling models in reducing HIV infection and mitigating risky HIV-related sexual behavior. Such studies may provide evidence to inform better HIV prevention and control policies and programs among taxi drivers and commercial motorcyclists in SSA.