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BMC Public Health
Published in: BMC Public Health 1/2023

Open Access 01-12-2023 | Human Immunodeficiency Virus | Research

Policymakers’ and healthcare providers’ perspectives on the introduction of oral pre-exposure prophylaxis for key populations in Ghana

Authors: Henry Nagai, Edward Adiibokah, Henry Tagoe, Waimar Tun, Nanlesta A. Pilgrim, Augustine Ankomah, Yussif Ahmed Abdul Rahman, Stephen Ayisi Addo, Stephen Kyeremeh Atuahene, Emmanuel Essandoh, Sean Maher, Mark Kowalski

Published in: BMC Public Health | Issue 1/2023

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Abstract

Background

Key populations (KPs) such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID), and their partners contribute more than a quarter (27.5%) of new HIV infection in Ghana. Oral pre-exposure prophylaxis (PrEP) can substantially reduce HIV acquisition among this group. While the available research indicates KPs willingness to take PrEP in Ghana, little is known about the position of policymakers and healthcare providers on the introduction of PrEP for KPs.

Methods

Qualitative data were collected from September to October 2017 in the Greater Accra (GA) and Brong-Ahafo (BA) regions of Ghana. Key informant interviews were conducted with 20 regional and national policymakers and supplemented with In-depth Interviews with 23 healthcare providers to explore their level of support for PrEP and their perspectives on challenges and issues to consider for oral PrEP implementation in Ghana. Thematic content analysis was used to unearth the issues emerging from the interviews.

Results

Policymakers and healthcare providers in both regions expressed strong support for introducing PrEP for KPs. Key concerns regarding oral PrEP introduction included potential for behavioral disinhibition, non-adherence and side effects of medication, cost and long-term financial implications, and stigma related to HIV and key populations. Participants stressed the need to integrate PrEP into existing services and the provision of PrEP should start with high risk groups like sero-discordant couples, FSWs and MSM.

Conclusions

Policymakers and providers recognize the value of PrEP in cubing new HIV infections but have concerns about disinhibition, non-adherence, and cost. Therefore, the Ghana health service should roll-out a range of strategies to address their concerns including: sensitization with providers to mitigate underlying stigma towards KPs, particularly MSM, integration of PrEP into existing services, and innovative strategies to improve continued use of PrEP.
Literature
1.
UN General Assembly. UN General Assembly. Vol. 17020. 2016.
2.
Schaefer R, Schmidt HMA, Ravasi G, Mozalevskis A, Rewari BB, Lule F, et al. Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study. Lancet HIV. 2021;8(8):e502–10.CrossRefPubMedPubMedCentral
3.
Ahmed N, Pike C, Bekker LG. Scaling up pre-exposure prophylaxis in sub-saharan Africa. Curr Opin Infect Dis. 2019;32(1):24–30.CrossRefPubMed
4.
World Health Organization. Guideline on When To Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. 2015.
5.
Ali H, Amoyaw F, Baden D, Durand L, Bronson M, Kim A, et al. Ghana’s HIV epidemic and PEPFAR’s contribution towards epidemic control. Ghana Med J. 2019 Mar;53(1):59–62.
6.
Ghana AIDS, Commission. Ghana’s HIV Fact Sheet 2019: Sub-National Estimates. Vol. 523. 2020.
7.
Cáceres CF, Borquez A, Klausner JD, Baggaley R, Beyrer C. Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy. J Int AIDS Soc. 2016;19(7Suppl 6):21108.CrossRefPubMedPubMedCentral
8.
Macqueen KM, Johnson L, Alleman P, Akumatey B. Pregnancy Prevention Practices among women with multiple partners in an HIV Prevention Trial background: Women enrolled in microbicide and pre-exposure.
9.
Ogunbajo A, Leblanc NM, Kushwaha S, Boakye F, Smith MDRR, Nelson LRE, et al. Knowledge and acceptability of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Ghana. AIDS Care. 2020;32(3):330–6.CrossRefPubMed
10.
Eakle R, Weatherburn P, Bourne A. Understanding user perspectives of and preferences for oral PrEP for HIV prevention in the context of intervention scale-up: a synthesis of evidence from sub-saharan Africa. J Int AIDS Soc. 2019;22:30–9.CrossRef
11.
Eakle R, Bourne A, Mbogua J, Mutanha N, Rees H. Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa. J Int AIDS Soc. 2018 Feb;21(2).
12.
Emmanuel G, Folayan M, Undelikwe G, Ochonye B, Jayeoba T, Yusuf A, et al. Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria. BMC Public Health. 2020;20(1):1–10.CrossRef
13.
Review AL. WHAT ’ S OUT THERE ON PrEP A Literature Review. 2017;(May).
14.
Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, et al. A Global Estimate of the acceptability of pre-exposure Prophylaxis for HIV among Men who have sex with men: a systematic review and Meta-analysis. AIDS Behav. 2018;22(4):1063–74.CrossRefPubMed
15.
Nagai H, Tagoe H, Tun W, Adiibokah E, Ankomah A, Rahman YAA, et al. Perspectives of policymakers on the introduction and Scale-Up of HIV Self-Testing and Implication for National HIV Programming in Ghana. Front public Heal. 2021;9:694836.CrossRef
16.
Koduah A, Agyepong IA, van Dijk H. Towards an explanatory framework for national level maternal health policy agenda item evolution in Ghana: an embedded case study. Heal Res Policy Syst. 2018;16(1):1–16.
17.
18.
19.
Morgan DL. Qualitative content analysis: a guide to paths not taken. Qual Heal Res. 1993;3:112–21.CrossRef
20.
21.
Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness Criteria. Int J Qual Methods. 2017;16(1):1–13.CrossRef
22.
23.
Ghana AIDS, Commission. Draft,Ghana national HIV & AIDS strategic plan 2021–2025.
24.
25.
Irungu EM, Mugwanya KK, Mugo NR, Bukusi EA, Donnell D, Odoyo J et al. Integration of pre-exposure prophylaxis services into public HIV care clinics in Kenya: a pragmatic stepped-wedge randomised trial. Lancet Glob Heal [Internet]. 2021;9(12):e1730–9. Available from: https://​doi.​org/​10.​1016/​S2214-109X(21)00391-0.
26.
Ahmed K, Baeten JM, Beksinska M, Bekker LG, Bukusi EA, Donnell D, et al. HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial. Lancet. 2019;394(10195):303–13.CrossRef
27.
Dettinger JC, Kinuthia J, Pintye J, Mwongeli N, Gómez L, Richardson BA, et al. PrEP implementation for mothers in Antenatal Care (PrIMA): study protocol of a cluster randomised trial. BMJ Open. 2019 Mar;9(3):e025122.
28.
Drainoni M-L, Biancarelli DL, Leech AA, Sullivan M, Bazzi AR. Implementing a Pre-Exposure Prophylaxis intervention for Safer Conception among HIV Serodiscordant couples: recommendations for Health Care Providers. J Health Dispar Res Pract. 2018;11(2):19–33.PubMedPubMedCentral
29.
30.
Pintye J, Kinuthia J, Roberts DA, Wagner AD, Mugwanya K, Abuna F, et al. Brief report: integration of PrEP services into routine antenatal and postnatal care: experiences from an implementation program in western Kenya. J Acquir Immune Defic Syndr. 2018 Dec;79(5):590–5.
31.
Kasaro MP, Sindano N, Chinyama M, Mudenda M, Chilaisha F, Price JT, et al. Integration of HIV Prevention with sexual and Reproductive Health Services: evidence for Contraceptive Options and HIV Outcomes Study experience of integrating oral pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia. Front Reprod Heal. 2021;3:684717.CrossRef
32.
Mugwanya KK, Pintye J, Kinuthia J, Abuna F, Lagat H, Begnel ER, et al. Integrating preexposure prophylaxis delivery in routine family planning clinics: a feasibility programmatic evaluation in Kenya. PLoS Med. 2019 Sep;16(9):e1002885.
33.
34.
O Murchu E, Marshall L, Teljeur C, Harrington P, Hayes C, Moran P, et al. Oral pre-exposure prophylaxis (PrEP) to prevent HIV: a systematic review and meta-analysis of clinical effectiveness, safety, adherence and risk compensation in all populations. BMJ Open. 2022 May;12(5):e048478.
35.
Laurent C, Dembélé Keita B, Yaya I, Le Guicher G, Sagaon-Teyssier L, Agboyibor MK et al. HIV pre-exposure prophylaxis for men who have sex with men in west Africa: a multicountry demonstration study. Lancet HIV [Internet]. 2021 Jul 1;8(7):e420–8. Available from: https://​doi.​org/​10.​1016/​S2352-3018(21)00005-9.
36.
Villela LM, Veloso VG, Hoagland B, Fernandes NM, Kallas EG, Madruga JV, et al. Possible risk compensation, attitudes, and beliefs among brazilian individuals potentially eligible for pre-exposure prophylaxis. Int J STD AIDS. 2021;32(9):806–15.CrossRefPubMed
37.
Cáceres CF, Koechlin F, Goicochea P, Sow PS, O’Reilly KR, Mayer KH, et al. The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention. J Int AIDS Soc. 2015;18(Suppl 3):1–9.
38.
McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53–60.CrossRefPubMedPubMedCentral
39.
Poku RA, Owusu AY, Mullen PD, Markham C, McCurdy SA. HIV antiretroviral medication stock-outs in Ghana: contributors and consequences. Afr J AIDS Res. 2017;16(3):231–9.CrossRefPubMed
40.
Moriarty K, Genberg B, Norman B, Reece R. The Effect of Antiretroviral Stock-Outs on Medication Adherence among Patients living with HIV in Ghana: a qualitative study. J Assoc Nurses AIDS Care. 2018;29(2):231–40.CrossRefPubMed
41.
Gomez GB, Borquez A, Case KK, Wheelock A, Vassall A, Hankins C. The cost and impact of scaling up pre-exposure Prophylaxis for HIV Prevention: a systematic review of cost-effectiveness modelling studies. Vol. 10, PLoS Med. 2013.
42.
43.
Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, et al. Rate and predictors of ineffective HIV Protection in African Men who have sex with men taking Pre-Exposure Prophylaxis. AIDS Behav. 2022 Nov;26(11):3524–37.
44.
Haberer JE, Baeten JM, Campbell J, Wangisi J, Katabira E, Ronald A et al. Adherence to antiretroviral prophylaxis for HIV Prevention: a Substudy Cohort within a clinical trial of serodiscordant couples in East Africa. PLoS Med. 2013;10(9).
45.
Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-Based Preexposure Prophylaxis for HIV infection among african women. N Engl J Med. 2015;372(6):509–18.CrossRefPubMedPubMedCentral
46.
Sidebottom D, Ekström AM, Strömdahl S. A systematic review of adherence to oral pre-exposure prophylaxis for HIV - how can we improve uptake and adherence? BMC infect dis. 2018 Nov;18(1):581.
47.
Ayala G, Makofane K, Santos G-M, Beck J, Do TD, Hebert P, et al. Access to Basic HIV-Related Services and PrEP acceptability among men who have sex with Men Worldwide: barriers, facilitators, and implications for Combination Prevention. J Sex Transm Dis. 2013;2013:953123.PubMedPubMedCentral
48.
Dubov A, Galbo PJ, Altice FL, Fraenkel L. Stigma and shame experiences by MSM who take PrEP for HIV Prevention: a qualitative study. Am J Mens Health. 2018 Nov;12(6):1843–54.
49.
Golub SA. PrEP stigma: implicit and explicit drivers of disparity. Curr HIV/AIDS Rep. 2018 Apr;15(2):190–7.
50.
Karuga RN, Njenga SN, Mulwa R, Kilonzo N, Bahati P, O’reilley K, et al. How I wish this thing was initiated 100 years ago!” Willingness to take daily oral Pre-Exposure Prophylaxis among Men who have sex with men in Kenya. PLoS ONE. 2016;11(4):e0151716.CrossRefPubMedPubMedCentral
51.
Mimiaga MJ, Closson EF, Kothary V, Mitty JA. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. Arch Sex Behav. 2014 Jan;43(1):99–106.
52.
Bazzi AR, Yotebieng KA, Agot K, Rota G, Syvertsen JL. Perspectives on biomedical HIV prevention options among women who inject drugs in Kenya. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2018;30(3):343–6.CrossRef
53.
Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2013 Jul;17(6):2162–72.
Metadata
Title
Policymakers’ and healthcare providers’ perspectives on the introduction of oral pre-exposure prophylaxis for key populations in Ghana
Authors
Henry Nagai
Edward Adiibokah
Henry Tagoe
Waimar Tun
Nanlesta A. Pilgrim
Augustine Ankomah
Yussif Ahmed Abdul Rahman
Stephen Ayisi Addo
Stephen Kyeremeh Atuahene
Emmanuel Essandoh
Sean Maher
Mark Kowalski
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2023
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-023-15871-w

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