PrEP demand creation can attract higher risk individuals and be a gateway to other HIV services in Ghana

BACKGROUND: The PEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project implemented pre-exposure prophylaxis (PrEP) for the first time in Ghana. The purpose of the program was to initiate higher risk men who have sex with men (MSM), female sex workers (FSWs), and transgender individuals on PrEP to reduce HIV acquisition.
DESCRIPTION: PrEP was implemented in six health facilities in the Greater Accra and Ashanti regions from October 2020 to September 2021. Key-population-led community-based organizations (CBOs) utilized social media and online networks to conduct demand creation activities and were not physically present in hot spots or gathering places. Once clients were reached through social media, peer educators referred them for eligibility screening at the facility or mobile clinic. HIV testing was provided for the first time during the screening process. Screening included a behavioral risk assessment, HIV test, and a review of possible acute infection or recent exposure to HIV. If an individual had a recent HIV exposure, post-exposure prophylaxis (PEP) was recommended. We reviewed the PrEP screening through initiation cascade, and used a chi-square test to determine if there were differences in PrEP eligibility between FSW and MSM/TG.
LESSONS LEARNED: There was a high demand for PrEP among all KP (Table 1); however, it was found that a higher portion of MSM and TG were not able to start PrEP because of being HIV+ or other ineligibility criteria compared to FSW (Table 1). A chi-square test of independence showed that KP type was associated with PrEP eligibility (p<.001).

Table1: PrEP Cascade'screening to PrEP initiation

	FSW	MSM & TG
Screened for PrEP	975	567
HIV+	9	65
Case Finding	0.91%	11.5%
Referred/Initiated on PEP	3	13
Total Ineligible for PrEP including PEP including HIV+	25	79
% Ineligible	2.6%	13.9%
Eligible for PrEP	950	488
Initiated on PrEP	867	462
Chi-square	p<.001

CONCLUSIONS: There was high demand for PrEP services among higher risk MSM but were ineligible due to being HIV positive, or having another ineligibility criteria, which demonstrates the need for expanded HIV prevention services. PrEP offers an opportunity to reach individuals who may not otherwise seek services.

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