Increasing uptake of PrEP through community distribution: the case of a CSO in Western Region of Ghana

BACKGROUND: PrEP is a very efficacious tool for HIV prevention among key populations. However, this is dependent on its availability, accessibility, uptake and usage. While initial PrEP Policy in Ghana required that it should be delivered only at the health facility, this was not in sync with international best practice of multiple delivery channels, and led to low uptake.As a pioneering CSO in HIV service provision for key populations (KPs) in Ghana, Maritime Life Precious Foundation (MLPF) piloted a community based service delivery model for PrEP.
DESCRIPTION: MLPF, a sub- grantee CSO of the JSI-led USAID Strengthening the Care Continuum project, provides HIV services including PrEP to key populations in the Western region of Ghana. Within the period of April to June 2021, MLPF introduced community distribution of PrEP in its outreach activities by adding a team of trained nurses responsible for PrEP to the already existing HTS outreach team. KPs who test positive are put on ART and those testing negative are referred to the PrEP team for PrEP initiation at the same venue. This approach was carried out in two of the project sites.
LESSONS LEARNED: Within the first six months (October 2020 to March 2021) of facility distribution of PrEP, before the introduction of community distribution, only 179 clients were initiated on PrEP across all our implementing sites. In contrast, the new community-based delivery channel which was carried out within the period of three months (April to June 2021) saw 330 clients initiated on PrEP. From the figures above, MLPF has achieved 184% increment in PrEP initiation within a shorter period which suggests that community distribution is gaining acceptance among the target population and it should be replicated across other project sites.
CONCLUSIONS: Community based distribution of PrEP is very effective and should be employed to compliment the facility based initiatives. Implementing partners should not limit PrEP to health facilities only but consider more delivery channels such as community distribution. Results of this case study have intrinsic benefits for the review of national PrEP policy.

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