Attitudes toward and medical decisions on uptake of pre-exposure prophylaxis among young Ghanaians: A quasi-experimental one group study
Main Article Content
Abstract
This study examined attitudes toward pre-exposure prophylaxis (PrEP) and medical decision making about PrEP uptake among educated young Ghanaians in Lower Manya Krobo Municipality (LMKM) to prevent HIV/AIDS. Lower Manya Krobo Municipality has a history of high HIV infection. There is paucity of studies on attitudes towards and medical decisions on PrEP among Ghanaians. PrEP is currently not approved in Ghana and West Africa generally. Efforts are, however, being made to study the possible use of the intervention in Ghana, against a background of generalized HIV infection, and increasing infection among the youth. We used primary data administered through mostly closed-ended questionnaires to 261 respondents. A quasi-experimental one group study was adopted. Respondents were asked the same questions on attitudes towards and medical decisions on PrEP before and after watching a six-minute YouTube video on PrEP. ANOVA was used to examine statistical significance between the paired, pre-and-post data. The Wilcoxon signed rank test helped with conclusions about the mean difference between the paired responses. The findings corroborated with previous literature regarding high sexual risk among the young people. There was a statistically significant effect of the video on attitudes and medical decisions regarding use of PrEP. It seemed that if PrEP were available, the study participants would uptake it to proactively protect themselves from HIV infection. They also had a higher inclination of using PrEP if a medical officer recommended its use, and its side effects were minimal. Statistically significant gendered differences showed that female respondents were less concerned about being stigmatized as having HIV if they took PrEP and were also more likely to respond favorably to the recommendation of a physician to use the intervention, compared to their male counterparts. Public education on PrEP use should consider the involvement of a medical figure.
Keywords:
HIV/AIDS, pre-exposure prophylaxis (PrEP), quasi-experimental design, youth, Lower Manya Krobo Municipality, Ghana
Article Details
How to Cite
OWUSU, Adobea Yaa et al.
Attitudes toward and medical decisions on uptake of pre-exposure prophylaxis among young Ghanaians: A quasi-experimental one group study.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5676>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5676.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. McCormack S, Dunn DT, Desai M, et al. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomized trial. Lancet 2016:387(100013):53-60. https://doi.org/10.1016/S0140-6736(15)00056-2
2. Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. The New England Journal of Medicine 2012:367:399-410. Doi:10.1056/NEJMoa1108524.
3. Zhang L, Song Y, Zheng X, Liu Y & Chen H. The experience of healthcare workers to HIV pre-exposure prophylaxis (PrEP) implementation in low-and middle-income countries: A systematic review and qualitative meta-synthesis. Frontiers in Public Health 2023;11:1224461. doi:10.3389/fpubh.2023.1224461.
4. Davey DL, Daniels J, Beard C, et al,. Healthcare provider knowledge and attitudes about pre-exposure prophylaxis (PrEP) in pregnancy in Cape Town, South Africa. AIDS Care 2020;32(10):1290-1294. Doi:10.1080/09540121.2020.1782328
5. Golub SA. PrEP stigma: Implicit and explicit drivers of disparity. Current HIV/AIDS Rep, 2018;2:190-197. Doi:10.1007/s11904-018-0385-0.
6. Gyamerah AO, Kinzer E, Aidoo-Frimpong G, et al. PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and NSM, trans, women, and gender diverse individuals living with HIV. PLOS Global Public Health 2023;3(6): e0001956. https://doi.org/10.1371/journal.pgph.0001956
7. Reyniers T, Babo SAY, Ouedraogo M, et al. Strategies to improve PrEP uptake among West African men who have sex with men: A multi-country qualitative study. Frontiers in Public Health 2023;11:1165327. https://doi.org/10.3389/fpubh.2023.1165327
8. Muhumuza R, Ssemata AS, Kakande A, et al. Exploring perceived barriers and facilitators of PrEP uptake among young people in Uganda, Zimbabwe, and South Africa. Archives of Sexual Behavior 2021;50:1729-1742. Doi:10.1007/s10508-020-01880-y
9. Giovenco D, Gill K, Fynn L, et al. Experiences of oral pre-exposure prophylaxis (PrEP) use disclosure among South African adolescent girls and young women and its perceived impact on adherence. PLoS One 2021;16(3):e0248307. Doi:10.1371/journal.pone.0248307 https://doi.org/10.1371/journal.pone.0248307 PMID: 33667264
10. Pintye J, Beima-Sofie KM, Makabong OP, et al. HIV-Uninfected Kenyan Adolescent and Young Women Share Perspectives on Using Pre-Exposure Prophylaxis During Pregnancy. AIDS Patient Care STDS 2018;32(12):538–44. https://doi.org/10.1089/apc.2018.0058
11. Jackson-Gibson M, Ezema A, Orero W, et al. Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya. BMC Public Health 2021;21:1284. https://doi.org/10.1186/s12889-021-11335-
12. Karim S & Baxter C. HIV pre-exposure prophylaxis implementation in Africa: Some early lessons. The Lancet 2021;9: e1634-e1635. https://doi.org/10.1016/S2214-109X(21)00460-5
13. Mugo NR, Ngure K, Kiragu M, Irungu E & Kilonzo N. PrEP for Africa: What we have learnt and what is needed to move to program implementation. Current Opinion HIV AIDS 2016;11(1):80-86. Doi:10.1097/COH.0000000000000224
14. Koss CA, Havlir DV, Ayieko J, et al. HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda. PLOS Medicine 2021;18(2):e1003492. https://doi.org/10.1371/journal.pmed.1003492
15. Masyuko S, Mukui I, Njathi O, et al. PrEP roll out in a national public sector program: The Kenyan case study. Sexual Health 2018;15(6):578-586. DOI:10.1071/SH18090
16. Cassidy T, Ntuli N, Kilani C, et al. Delivering PrEP to young women in a low-income setting in South Africa: Lessons for providing both convenience and support. AIDS and Behavior 2022, 26, 147-159. https://doi.org/10.1007/s10461-021-03366-x
17. Rousseau E, Baeten J, Morton J. et al. Association between contraceptive use and PrEP uptake and continuation in adolescent girls and young women in Cape Town, South Africa. Abstract, IAS 2019; Mexico City, Mexico. Retrieved at: https://www.prepwatch.org/wp-content/uploads/2022/03/IAS2019_Rousseau_PrEPandContraception.pdf
18. Rousseau E, Bekker L, Julies R et al. A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa. BMC Health Services Research 2021;21(888). https://doi.org/10.1186/s12913-021-06920-4
19. Owusu AY & Laar AK. Managing HIV-Positive Serostatus in Ghana’s Most HIV Concentrated District: Self-Perceived Explanations and Theoretical Discourse. African Journal of AIDS Research 2018;17(1). Doi:10.2989/16085906.2017.1419268.
20. Tenkorang EY, Owusu AY, Laar AK & Yeboah EH. Housing, psychosocial and adherence counseling among HIV+ persons in Ghana. Health Promotion International 2019;34(2):204-214. https://doi.org/10.1093/heapro/dax072.
21. YouTube. What is PrEP? 2017. Retrieved at: What is PrEP? - YouTube
22. UNAIDS. Country factsheets: Ghana, 2016. 2017. Available from: http://www.unaids.org/en/regionscountries/countries/ghana
23. Adam A, Fusheini A, Ayanore MA, et al. HIV stigma and status disclosure in three municipalities in Ghana. Annals of Global Health 2021, 87(1):49,1-12. Doi:10.5334/aogh.3120
24. Nyblade L, Stockton M, Saalim K, et al. Using a mixed-methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana. Journal of the International AIDS Society 2022;25(S1):e25908. Doi:10.1002/jia2.25908.
25. Owusu AY. Experiences of new diagnoses among HIV-positive persons: implications for public health. BMC Public Health 2022;22:538. https://doi.org/10.1186/s12889-022-12809-6.
26. Johnson M, Samarina A, Xi H, et al. Barriers to access to care reported by women living with HIV across 27 countries. AIDS Care 2015;27(10):1220-1230. Doi:10.1080/09540121.
27. Ramjee G & Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Research and Therapy 2013;10(30). https://doi.org/10.1186/1742-6405-10-30
28. Birdthistle I, Tanton C, de Graaf K, Schaffnit SB, Tanser F & Slaymaker E. Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: A systematic review and meta-analysis. Lancet Global Health 2019;7:e1521-1540. Doi:10.1016/S2214-109X(19)30410-3.
29. Lewis L, Khaesany AB, Humphries H. et al. (2022). HIV incidence and associated risk factors in adolescent girls and young women in South Africa: A population-based cohort study. PLOS One 2022;17(12):e0279289. https://doi.org/10.1371/journal.pone.0279289
30. Centers for Disease Control and Prevention. Preventing HIV in youth: Successes and challenges in 15 sub-Saharan countries. 2023 Retrieved at: https://www.cdc.gov/globalhivtb/who-we-are/success-stories/success-story-pages/preventing-hiv-among-african-youth.html
31. Machado DA, Carvalho A & Riera R. Adolescent pre-exposure prophylaxis for HIV prevention: current perspectives, Adolescent Health, Medicine and Therapeutics 2017;137-148, Doi:10.2147/AHMT.S112757
32. Ghana Statistical Service Population and Housing Census. Summary Report of Final Results. 2021. Retrieved at https://census2021.statsghana.gov.gh/.
33. Ofori M, Nyame EA & Eshun I. Students’ knowledge and sources of information on HIV/AIDS: Evidence from Lower Manya Krobo municipality of the Eastern region of Ghana. Universal Journal of Social Science and Humanities 2022;2(4):186-200. Doi:10.31586/ujssh.2022.390
34. Ghana AIDS Commission. National and sub-National HIV and AIDS estimates and projections. 2019. Retrieved at: https://www.ghanaids.gov.gh/mcadmin/Uploads/2019%20National%20and%20Sub-National%20Estimates%20and%20Projections%20Dissemination%2021.07.2020.pdf
35. Ghana AIDS Commission/Citinewsroom.com. Ghana’s HIV Fact Sheet 2022. 2023. Available at: https://citinewsroom.com/wp-content/uploads/2023/08/2022_HIV_Estimates_Fact_Sheetfinal.pdf. (Accessed February 24, 2023).
36. Owusu AY. A gendered analysis of living with HIV/AIDS in the Eastern region of Ghana. BMC Public Health 2020;20:75. https://doi.org/10.1186/s12889-020-08702-9
37. Teye-kau M, Tenkorang EY, & Adjei PB. Revisiting the housing-health relationship for HIV-positive persons: Qualitative evidence from Lower Manya Krobo District, Ghana. Qualitative Health Research 2018; 28:1217-1228. Doi:10.1177/1049732318764646
38. Langmagne S. High HIV/AIDS prevalence in a suburban area in Ghana: A context analysis of its relationship to human trafficking. Ph.D Thesis. Sociology Department. University of Saskatchewan, Canada. 2016. Retrieved at http://hdl.handle.net/10388/7279
39. Lund R, Agyei-Mensah S. Queens as mothers: the role of the traditional safety net of care and support for HIV/AIDS orphans and vulnerable children in Ghana. Geography Journal 2008;7193-106. Doi:10.1007/s10708-008-9145-9.
40. Owusu AY, Teye-Kau M, & Tenkorang EY. The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana. Health Promotion International 2021;36(2):384-396. Doi:10.1093/heapro/daaa062.
41. Wilcoxon F. Individual Comparisons by Ranking Methods. Biometrics Bulletin 1945;1(6):80–83. https://doi.org/10.2307/3001968
42. Irungu EM, Mugwanya KK, Mugo NR, et al. Integration of pre-exposure prophylaxis services into public HIV care clinics in Kenya: A pragmatic stepped-wedge randomized trial. The Lancet 2021;9:e1730-e1739. Doi:10.1016/S2214-109X(21)00391-0.
43. Wyatt MA, Pisarski EE, Kriel Y. Influences on PrEP uptake and adherence among South African women during periconception and pregnancy: A qualitative analysis. AIDS & Behavior 2023;27(1):208-217. Doi:10.1007/s10461-022-03757-8
44. Beesham I, Milford C, Smit J, et al. Post-trial access to use of pre-exposure prophylaxis in Durban, South Africa. BMC Public Health 2023;23:1210. https://doi.org/10.1186/s12889-023-16139-z
45. Koss CA, Charlebois ED, Ayieko J, et al. Uptake, engagement, and adherence to pre-exposure prophylaxis offered after population HIV testing in rural Kenya and Uganda: 72-week interim analysis of observational data from the SEARCH study. The Lancet 2020, 7, e249-e261. https://doi.org/10.1016/S2352-3018(19)30433-3
46. Wahome E, Graham SM, Thiong’o A, et al. PrEP uptake and adherence in relation to HIV-1 incidence among Kenyan men who have sex with men. EClinicalMedicine 2020;26:10054. https://doi.org/10.1016/j.eclinm.2020.100541
47. Centers for Disease Control and Prevention. Pre-Exposure Prophylaxis (PrEP). 2022. Available from: https://www.cdc.gov/hiv/risk/prep/index.html (Accessed Feb 26, 2024).
48. Rolle C, Rosenberg ES, Siegler AJ, et al. Challenges in translating PrEP interest into uptake in an observational study of young Black MSM. Journal of Acquired Immune Deficiency Syndrome 2017;76(3):250-258. Doi:10.1097/QAI.0000000000001497.
49. Owusu AY. Social contexts of living with HIV/AIDS in the Eastern Region of Ghana. İstanbul Üniversitesi Sosyoloji Dergisi. Istanbul University Journal of Sociology 2019;39(2):425-454. https://doi.org/10.26650/SJ.2019.39.2.0109.
50. Mufune P. Poverty and HIV/AIDS in Africa: Specifying the connections. Social Theory and Health 2015, 13(1), 1-29. https://doi.org/10.1057/sth.2014.14
51. Sedziafa AP, Tenkorang EY, Owusu AY. Kinship and intimate partner violence against married women in Ghana: a qualitative exploration. Journal of Interpersonal Violence 2016;33(14):2197-2224. Doi:10.1177/0886260515624213
52. UNAIDS. (2023). Global HIV & AIDS statistics — Fact sheet. Available from: https://www.unaids.org/en/resources/fact-sheet. (Accessed Feb 26, 2024).
53. Glover E.K., Bannerman A., Pence B.W., et al. Sexual health experiences of adolescents in three Ghanaian towns. International family planning perspectives. 2003;1:32-40. Doi:10.1363/ifpp.29.032.03.
54. Sowah BA. Risky Sexual Behaviors among Adolescents in the La-Dadekotopon Municipality of the Greater Accra Region of Ghana (Doctoral dissertation, University of Ghana). 2016.
2. Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. The New England Journal of Medicine 2012:367:399-410. Doi:10.1056/NEJMoa1108524.
3. Zhang L, Song Y, Zheng X, Liu Y & Chen H. The experience of healthcare workers to HIV pre-exposure prophylaxis (PrEP) implementation in low-and middle-income countries: A systematic review and qualitative meta-synthesis. Frontiers in Public Health 2023;11:1224461. doi:10.3389/fpubh.2023.1224461.
4. Davey DL, Daniels J, Beard C, et al,. Healthcare provider knowledge and attitudes about pre-exposure prophylaxis (PrEP) in pregnancy in Cape Town, South Africa. AIDS Care 2020;32(10):1290-1294. Doi:10.1080/09540121.2020.1782328
5. Golub SA. PrEP stigma: Implicit and explicit drivers of disparity. Current HIV/AIDS Rep, 2018;2:190-197. Doi:10.1007/s11904-018-0385-0.
6. Gyamerah AO, Kinzer E, Aidoo-Frimpong G, et al. PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and NSM, trans, women, and gender diverse individuals living with HIV. PLOS Global Public Health 2023;3(6): e0001956. https://doi.org/10.1371/journal.pgph.0001956
7. Reyniers T, Babo SAY, Ouedraogo M, et al. Strategies to improve PrEP uptake among West African men who have sex with men: A multi-country qualitative study. Frontiers in Public Health 2023;11:1165327. https://doi.org/10.3389/fpubh.2023.1165327
8. Muhumuza R, Ssemata AS, Kakande A, et al. Exploring perceived barriers and facilitators of PrEP uptake among young people in Uganda, Zimbabwe, and South Africa. Archives of Sexual Behavior 2021;50:1729-1742. Doi:10.1007/s10508-020-01880-y
9. Giovenco D, Gill K, Fynn L, et al. Experiences of oral pre-exposure prophylaxis (PrEP) use disclosure among South African adolescent girls and young women and its perceived impact on adherence. PLoS One 2021;16(3):e0248307. Doi:10.1371/journal.pone.0248307 https://doi.org/10.1371/journal.pone.0248307 PMID: 33667264
10. Pintye J, Beima-Sofie KM, Makabong OP, et al. HIV-Uninfected Kenyan Adolescent and Young Women Share Perspectives on Using Pre-Exposure Prophylaxis During Pregnancy. AIDS Patient Care STDS 2018;32(12):538–44. https://doi.org/10.1089/apc.2018.0058
11. Jackson-Gibson M, Ezema A, Orero W, et al. Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya. BMC Public Health 2021;21:1284. https://doi.org/10.1186/s12889-021-11335-
12. Karim S & Baxter C. HIV pre-exposure prophylaxis implementation in Africa: Some early lessons. The Lancet 2021;9: e1634-e1635. https://doi.org/10.1016/S2214-109X(21)00460-5
13. Mugo NR, Ngure K, Kiragu M, Irungu E & Kilonzo N. PrEP for Africa: What we have learnt and what is needed to move to program implementation. Current Opinion HIV AIDS 2016;11(1):80-86. Doi:10.1097/COH.0000000000000224
14. Koss CA, Havlir DV, Ayieko J, et al. HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda. PLOS Medicine 2021;18(2):e1003492. https://doi.org/10.1371/journal.pmed.1003492
15. Masyuko S, Mukui I, Njathi O, et al. PrEP roll out in a national public sector program: The Kenyan case study. Sexual Health 2018;15(6):578-586. DOI:10.1071/SH18090
16. Cassidy T, Ntuli N, Kilani C, et al. Delivering PrEP to young women in a low-income setting in South Africa: Lessons for providing both convenience and support. AIDS and Behavior 2022, 26, 147-159. https://doi.org/10.1007/s10461-021-03366-x
17. Rousseau E, Baeten J, Morton J. et al. Association between contraceptive use and PrEP uptake and continuation in adolescent girls and young women in Cape Town, South Africa. Abstract, IAS 2019; Mexico City, Mexico. Retrieved at: https://www.prepwatch.org/wp-content/uploads/2022/03/IAS2019_Rousseau_PrEPandContraception.pdf
18. Rousseau E, Bekker L, Julies R et al. A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa. BMC Health Services Research 2021;21(888). https://doi.org/10.1186/s12913-021-06920-4
19. Owusu AY & Laar AK. Managing HIV-Positive Serostatus in Ghana’s Most HIV Concentrated District: Self-Perceived Explanations and Theoretical Discourse. African Journal of AIDS Research 2018;17(1). Doi:10.2989/16085906.2017.1419268.
20. Tenkorang EY, Owusu AY, Laar AK & Yeboah EH. Housing, psychosocial and adherence counseling among HIV+ persons in Ghana. Health Promotion International 2019;34(2):204-214. https://doi.org/10.1093/heapro/dax072.
21. YouTube. What is PrEP? 2017. Retrieved at: What is PrEP? - YouTube
22. UNAIDS. Country factsheets: Ghana, 2016. 2017. Available from: http://www.unaids.org/en/regionscountries/countries/ghana
23. Adam A, Fusheini A, Ayanore MA, et al. HIV stigma and status disclosure in three municipalities in Ghana. Annals of Global Health 2021, 87(1):49,1-12. Doi:10.5334/aogh.3120
24. Nyblade L, Stockton M, Saalim K, et al. Using a mixed-methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana. Journal of the International AIDS Society 2022;25(S1):e25908. Doi:10.1002/jia2.25908.
25. Owusu AY. Experiences of new diagnoses among HIV-positive persons: implications for public health. BMC Public Health 2022;22:538. https://doi.org/10.1186/s12889-022-12809-6.
26. Johnson M, Samarina A, Xi H, et al. Barriers to access to care reported by women living with HIV across 27 countries. AIDS Care 2015;27(10):1220-1230. Doi:10.1080/09540121.
27. Ramjee G & Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Research and Therapy 2013;10(30). https://doi.org/10.1186/1742-6405-10-30
28. Birdthistle I, Tanton C, de Graaf K, Schaffnit SB, Tanser F & Slaymaker E. Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: A systematic review and meta-analysis. Lancet Global Health 2019;7:e1521-1540. Doi:10.1016/S2214-109X(19)30410-3.
29. Lewis L, Khaesany AB, Humphries H. et al. (2022). HIV incidence and associated risk factors in adolescent girls and young women in South Africa: A population-based cohort study. PLOS One 2022;17(12):e0279289. https://doi.org/10.1371/journal.pone.0279289
30. Centers for Disease Control and Prevention. Preventing HIV in youth: Successes and challenges in 15 sub-Saharan countries. 2023 Retrieved at: https://www.cdc.gov/globalhivtb/who-we-are/success-stories/success-story-pages/preventing-hiv-among-african-youth.html
31. Machado DA, Carvalho A & Riera R. Adolescent pre-exposure prophylaxis for HIV prevention: current perspectives, Adolescent Health, Medicine and Therapeutics 2017;137-148, Doi:10.2147/AHMT.S112757
32. Ghana Statistical Service Population and Housing Census. Summary Report of Final Results. 2021. Retrieved at https://census2021.statsghana.gov.gh/.
33. Ofori M, Nyame EA & Eshun I. Students’ knowledge and sources of information on HIV/AIDS: Evidence from Lower Manya Krobo municipality of the Eastern region of Ghana. Universal Journal of Social Science and Humanities 2022;2(4):186-200. Doi:10.31586/ujssh.2022.390
34. Ghana AIDS Commission. National and sub-National HIV and AIDS estimates and projections. 2019. Retrieved at: https://www.ghanaids.gov.gh/mcadmin/Uploads/2019%20National%20and%20Sub-National%20Estimates%20and%20Projections%20Dissemination%2021.07.2020.pdf
35. Ghana AIDS Commission/Citinewsroom.com. Ghana’s HIV Fact Sheet 2022. 2023. Available at: https://citinewsroom.com/wp-content/uploads/2023/08/2022_HIV_Estimates_Fact_Sheetfinal.pdf. (Accessed February 24, 2023).
36. Owusu AY. A gendered analysis of living with HIV/AIDS in the Eastern region of Ghana. BMC Public Health 2020;20:75. https://doi.org/10.1186/s12889-020-08702-9
37. Teye-kau M, Tenkorang EY, & Adjei PB. Revisiting the housing-health relationship for HIV-positive persons: Qualitative evidence from Lower Manya Krobo District, Ghana. Qualitative Health Research 2018; 28:1217-1228. Doi:10.1177/1049732318764646
38. Langmagne S. High HIV/AIDS prevalence in a suburban area in Ghana: A context analysis of its relationship to human trafficking. Ph.D Thesis. Sociology Department. University of Saskatchewan, Canada. 2016. Retrieved at http://hdl.handle.net/10388/7279
39. Lund R, Agyei-Mensah S. Queens as mothers: the role of the traditional safety net of care and support for HIV/AIDS orphans and vulnerable children in Ghana. Geography Journal 2008;7193-106. Doi:10.1007/s10708-008-9145-9.
40. Owusu AY, Teye-Kau M, & Tenkorang EY. The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana. Health Promotion International 2021;36(2):384-396. Doi:10.1093/heapro/daaa062.
41. Wilcoxon F. Individual Comparisons by Ranking Methods. Biometrics Bulletin 1945;1(6):80–83. https://doi.org/10.2307/3001968
42. Irungu EM, Mugwanya KK, Mugo NR, et al. Integration of pre-exposure prophylaxis services into public HIV care clinics in Kenya: A pragmatic stepped-wedge randomized trial. The Lancet 2021;9:e1730-e1739. Doi:10.1016/S2214-109X(21)00391-0.
43. Wyatt MA, Pisarski EE, Kriel Y. Influences on PrEP uptake and adherence among South African women during periconception and pregnancy: A qualitative analysis. AIDS & Behavior 2023;27(1):208-217. Doi:10.1007/s10461-022-03757-8
44. Beesham I, Milford C, Smit J, et al. Post-trial access to use of pre-exposure prophylaxis in Durban, South Africa. BMC Public Health 2023;23:1210. https://doi.org/10.1186/s12889-023-16139-z
45. Koss CA, Charlebois ED, Ayieko J, et al. Uptake, engagement, and adherence to pre-exposure prophylaxis offered after population HIV testing in rural Kenya and Uganda: 72-week interim analysis of observational data from the SEARCH study. The Lancet 2020, 7, e249-e261. https://doi.org/10.1016/S2352-3018(19)30433-3
46. Wahome E, Graham SM, Thiong’o A, et al. PrEP uptake and adherence in relation to HIV-1 incidence among Kenyan men who have sex with men. EClinicalMedicine 2020;26:10054. https://doi.org/10.1016/j.eclinm.2020.100541
47. Centers for Disease Control and Prevention. Pre-Exposure Prophylaxis (PrEP). 2022. Available from: https://www.cdc.gov/hiv/risk/prep/index.html (Accessed Feb 26, 2024).
48. Rolle C, Rosenberg ES, Siegler AJ, et al. Challenges in translating PrEP interest into uptake in an observational study of young Black MSM. Journal of Acquired Immune Deficiency Syndrome 2017;76(3):250-258. Doi:10.1097/QAI.0000000000001497.
49. Owusu AY. Social contexts of living with HIV/AIDS in the Eastern Region of Ghana. İstanbul Üniversitesi Sosyoloji Dergisi. Istanbul University Journal of Sociology 2019;39(2):425-454. https://doi.org/10.26650/SJ.2019.39.2.0109.
50. Mufune P. Poverty and HIV/AIDS in Africa: Specifying the connections. Social Theory and Health 2015, 13(1), 1-29. https://doi.org/10.1057/sth.2014.14
51. Sedziafa AP, Tenkorang EY, Owusu AY. Kinship and intimate partner violence against married women in Ghana: a qualitative exploration. Journal of Interpersonal Violence 2016;33(14):2197-2224. Doi:10.1177/0886260515624213
52. UNAIDS. (2023). Global HIV & AIDS statistics — Fact sheet. Available from: https://www.unaids.org/en/resources/fact-sheet. (Accessed Feb 26, 2024).
53. Glover E.K., Bannerman A., Pence B.W., et al. Sexual health experiences of adolescents in three Ghanaian towns. International family planning perspectives. 2003;1:32-40. Doi:10.1363/ifpp.29.032.03.
54. Sowah BA. Risky Sexual Behaviors among Adolescents in the La-Dadekotopon Municipality of the Greater Accra Region of Ghana (Doctoral dissertation, University of Ghana). 2016.