PrEP increases demand for HIV services among higher-risk key populations in Ghana

BACKGROUND: PrEP was implemented for the first time in Ghana through the PEPFAR- and USAID-funded project, Meeting Targets and Achieving Epidemic Control (EpiC) through the Key Population Investment Fund (KPIF). The purpose of the program was to initiate higher-risk men who have sex with men (MSM), female sex workers (FSWs), and transgender persons on PrEP to reduce HIV acquisition.
DESCRIPTION: PrEP was introduced in six health facilities in Greater Accra and Ashanti regions starting in August 2020. The program focused on higher-risk key populations (KPs) given the elevated HIV prevalence among these groups. PrEP screening was conducted at the facility and included a behavioral risk assessment, HIV test, possible acute infection, and/or recent exposure to HIV. If there was an exposure to HIV in the last 72 hours, post-exposure prophylaxis (PEP) was recommended for 28 days. Once the PEP cycle was completed, PrEP could be initiated. HIV Treatment was available for those who tested HIV positive.
LESSONS LEARNED: Availability of PrEP was found to create demand for HIV services among higher-risk MSM. About 27% of MSM were ineligible for PrEP since they tested HIV positive (28) during screening or were recently exposed to HIV and were initiated on PEP (7). National HIV prevalence among MSM is 18%; among FSWs, 4.6%. Case finding through PrEP services was 21.7% for MSM and 1.9% for FSWs, which could demonstrate that higher-risk MSM were coming for PrEP when they might not otherwise seek HIV services. (see Table 1).

Table 1. PrEP Cascade, screening for PrEP initiation, August'November 2020

	FSWs	MSM	Transgender People
Screened for PrEP	306	129	7
HIV positive	6	28	0
Case finding	1.9%	21.7%
Referred/initiated on PEP	3	7	0
Total ineligible for PrEP (HIV positive or PEP)	9	35
% Ineligible	2.94	27.13
Eligible for PrEP	282	91	7
Initiated on PrEP	198	83	7

CONCLUSIONS: A high demand for PrEP services was found among higher risk MSM. The addition of PrEP to an already established HIV program is an opportunity to reach MSM who may not otherwise seek services and initiate them on HIV treatment or PEP, facilitating prevention and achievement to the three 95 UNAIDS goals.