JSI Research & Training Institute, Inc, Accra, Ghana.
Population Council, Washington, DC, USA.
BMC Public Health. 2023 Jun 5;23(1):1065. doi: 10.1186/s12889-023-15871-w.
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.
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.
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.
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.
关键人群（Key populations，如性工作者、男男性行为者、注射毒品者及其伴侣）在加纳新感染艾滋病毒的人数中占比超过四分之一（27.5%）。口服暴露前预防（PrEP）可以显著减少这一人群的艾滋病毒感染率。虽然现有研究表明加纳的关键人群愿意接受 PrEP，但对于政策制定者和医疗保健提供者对关键人群引入 PrEP 的立场知之甚少。
2017 年 9 月至 10 月，在加纳大阿克拉（Greater Accra，GA）和布隆-阿哈福（Brong-Ahafo，BA）地区收集了定性数据。对 20 名区域和国家政策制定者进行了重点信息访谈，并补充了对 23 名医疗保健提供者的深入访谈，以探讨他们对 PrEP 的支持程度，以及对在加纳实施口服 PrEP 所面临的挑战和问题的看法。采用主题内容分析法挖掘访谈中出现的问题。
两个地区的政策制定者和医疗保健提供者都表示强烈支持为关键人群引入 PrEP。对于引入口服 PrEP 的主要关注包括行为抑制、不依从性和药物副作用、成本和长期财务影响，以及与艾滋病毒和关键人群相关的污名。参与者强调需要将 PrEP 纳入现有服务，并应从像血清不一致的夫妇、性工作者和男男性行为者等高风险群体开始提供 PrEP。
政策制定者和提供者认识到 PrEP 在减少新的艾滋病毒感染方面的价值，但对抑制、不依从性和成本存在担忧。因此，加纳卫生部门应推出一系列策略来解决这些问题，包括：向提供者进行宣传，以减轻对关键人群（尤其是男男性行为者）的潜在污名；将 PrEP 纳入现有服务；并采取创新策略提高 PrEP 的持续使用。
