PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and MSM, trans women, and gender diverse individuals living with HIV.
PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and MSM, trans women, and gender diverse individuals living with HIV.
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DOI：
10.1371/journal.pgph.0001956
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发表时间：
2023
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暴露前预防（PrEP）可以帮助减少加纳的顺式男性，跨式女性和出生时被分配为男性的性别多样性个体（男男性行为者，跨式女性和GDSM）中的艾滋病毒发病率，这是一个承担高艾滋病毒负担的群体。我们的研究审查了PrEP知识和可接受性，以及障碍和促进其吸收和实施，通过定性访谈与32男男性接触者，跨性别妇女和GDSM客户艾滋病毒感染者，14个服务提供者（SP），和四个关键的线人（KIs）在阿克拉，加纳。我们采访了参与者关于他们的PrEP知识，MSM是否会采取PrEP，以及什么因素会使它容易/难以吸收或实施PrEP。访谈记录进行了分析，使用主题分析。在加纳，男男性行为者、跨性别妇女、GDSM和SP/KIs对PrEP的使用和实施具有很高的可接受性。男男性接触者、跨性别妇女和GDSM对PrEP的兴趣、获得和使用受到交叉艾滋病毒和反同性恋污名的影响; PrEP的可负担性、可接受性和易用性（例如，消耗和副作用）;性偏好（例如，无安全套性行为与使用安全套），以及艾滋病毒风险认知。对PrEP使用和实施的障碍和促进因素提出的关切包括医疗问题（例如，性传播感染;耐药性）;社会行为问题（例如，耻辱，风险补偿，坚持问题）;和结构性障碍（例如，成本/负担能力、管理承诺、监测系统、政策指导）。有针对性的教育PrEP和正确使用它是必要的，以产生需求和消除男男性行为者，跨性别妇女和GDSM的副作用的担忧。免费、保密和方便地获得PrEP必须得到卫生系统的加强、明确的处方指南和对提供者的反污名培训的支持。
Pre-exposure prophylaxis (PrEP) could help reduce HIV incidence among cis men, trans women, and gender diverse individuals assigned male at birth who have sex with men (MSM, trans women, and GDSM) in Ghana, a group that bears a high HIV burden. Our study examined PrEP knowledge and acceptability, and barriers and facilitators to its uptake and implementation through qualitative interviews with 32 MSM, trans women, and GDSM clients living with HIV, 14 service providers (SPs), and four key informants (KIs) in Accra, Ghana. We interviewed participants about their PrEP knowledge, whether MSM would take PrEP, and what factors would make it easy/difficult to uptake or implement PrEP. Interview transcripts were analyzed using thematic analysis. There was high acceptability of PrEP use and implementation among MSM, trans women, GDSM, and SPs/KIs in Ghana. MSM, trans women, and GDSM interest in, access to, and use of PrEP were shaped by intersectional HIV and anti-gay stigma; PrEP affordability, acceptability, and ease of use (e.g., consumption and side effects); sexual preferences (e.g., condomless sex vs. condom use), and HIV risk perception. Concerns raised about barriers and facilitators of PrEP use and implementation ranged from medical concerns (e.g., STIs; drug resistance); social behavioral concerns (e.g., stigma, risk compensation, adherence issues); and structural barriers (e.g., cost/affordability, govern commitment, monitoring systems, policy guidance). Targeted education on PrEP and proper use of it is needed to generate demand and dispel worries of side effects among MSM, trans women, and GDSM. Free, confidential, and easy access to PrEP must be supported by health systems strengthening, clear prescription guidelines, and anti-stigma training for providers.