Bringing PrEP closer to clients in Ghana: supporting pre-exposure prophylaxis (PrEP) initiation and adherence in the community


BACKGROUND: In August 2020, thePEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project began implementing Pre-Exposure prophylaxis (PrEP) in two regions (Greater Accra, Ashanti) in Ghana to prevent HIV acquisition among key populations (KPs) at high risk, including men who have sex with men (MSM) and female sex workers (FSWs). After six months of implementation, demand for PrEP was decreasing and discontinuation was high. In response, EpiC adapted a differentiated service delivery (DSD) approach consisting of community-based PrEP services.
DESCRIPTION: EpiC implemented the community-based PrEP initiation and refill program using a private service mobile clinic and lay counselors, in the Greater Accra region. The mobile clinic began operation in October 2020, and lay counselor provision of community refills commenced in February 2021. Peer educators, lay counselors, and PrEP champions shared the mobile clinic's schedule and location with potential and current clients. With clients' permission, clinical staff informed lay counselors of who was due for refills so that lay counselors could follow up with those clients. Lay counselors also provided HIV testing, as appropriate, to avoid any lapse in PrEP services. They engaged with clients to establish a convenient meeting place for refills.
LESSONS LEARNED: Demand for community initiation and refills of PrEP was higher among FSWs than MSM. Of the 142 FSWs who initiated PrEP, 140 (98%) initiated PrEP through the mobile clinic. More than half (n=77 [55%]) of these individuals received their refills in the community versus the facility. The majority of MSM preferred to initiate PrEP and obtain refills at the facility over the community. Of the 157 MSM who initiated PrEP, 119 (76%) did so in the facility and 38 (24%) through the mobile clinic. For the 89 MSM who sought PrEP refills, 76 (85%) received them at the facility and 13 (15%) from lay counselors in the community.
CONCLUSIONS: Community initiation and refills of PrEP supported uptake and continuity of services among high-risk KP individuals in Ghana, but especially among the FSW. DSD options should be based on the unique needs and preferences of each population at risk of HIV.

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