HIV-preventive drug made accessible in Ghana

Health authorities have made an HIV-preventable medication available locally for the first time for users deemed vulnerable to risky sexual experience. 

The medication, now available at antiretroviral therapy health facilities on request, will be dispensed upon thorough analysis of the supposed risk claimed by the individual.

Known as pre-exposure prophylaxis (PrEP), the medication can prevent a user from contracting HIV during a sexual act and would be given to them only after the dispensing health facility has analysed their risk profile and are satisfied that they fit the criteria for obtaining the medication.

The Programme Manager of the National AIDS/STI Control Programme, Dr Stephen Ayisi Addo, who disclosed this, said people could go to a health facility to request that medication.

He stressed, however, that the health facility would assess the request on a case-by-case basis before they dispensed it to the individuals.

"You will have to make a case as to what and why you want to take PrEP," he said. 

Prescription only

The PrEP is a prescriptive drug taken ahead of a sexual activity to prevent getting HIV.

It reduces the risk of getting HIV from sex by about 99 per cent and reduces the risk of getting HIV from injection drug use by at least 74 per cent.

It comes in the form of tablets as well as long-acting injectables.

However, the injectable PrEP was a study drug that was not currently available and accessible for routine use.

When it becomes available, then instead of taking the medication, an individual would be injected for a period ahead of risk exposure.

The drug is easily accessible on a walk-in-to-purchase policy in some eastern African and southern African countries such as South Africa, Eswatina and Malawi, including HIV key populations.

However, in Ghana, at the moment, PrEP is distributed only to HIV key populations such as men who have sex with men (MSM), female sex workers and people in high risk relationships such as heterosexual serodiscordant couples, which is a relationship in which one partner is HIV positive and the other partner is negative.

The channels of distribution of PrEP to these key populations in Ghana are through their networks. So, just like the routine Antiretroviral Therapy (ART), PrEP is not available in pharmacies for one to openly procure.

Scaling up PrEP

Explaining why Ghana has up till now not scaled up the distribution of PrEP to cover the general population like the southern and eastern African countries aforementioned, Dr Ayisi Addo, who was speaking in an interview with the Daily Graphic, said unlike those countries, Ghana's HIV prevalence and the burden of the disease in the general population compared to MSM was not significant and that was why the PrEP programme was targeted mainly at the key populations.

PrEP was primarily for key populations, and so far as their guidelines were concerned, they're providing the service to this target group already.

He indicated that alternative prevention interventions such as condoms were available for anyone who wanted to have sex but was not sure of the HIV status of the partner.

"As long as condoms are readily available and formidable in preventing HIV, go for that.

Condoms are even cheaper than these medications, which can sometimes have side effects.

Even for MSM, when we give them PrEP, we add condoms to it.

 If there is no other alternative, then we will say use PrEP only, but we have other alternatives to prevent HIV," he explained.

Providing a history of PrEP in Ghana, Dr Ayisi Addo said the medication was introduced in Ghana in 2018 on a pilot basis and by 2020, the guidelines had been developed and the Ghana Health Service had since rolled it out to particularly key populations.

He said they started with post exposure Prophylaxis, which was given to someone who got exposed to a potential HIV transmission source, especially for health workers and rape survivors.

When asked whether Ghana has future plans of scaling up PrEP to the general public, the Programme Manager of the NACP expressed the hope that the country would get to a stage where to improve access, people would be able to go to a pharmacy to purchase them.

He explained that they were looking at a future where, like the automated teller systems, there would be a vending machine that could deliver services such as PrEP, condoms and self-test kits at people's convenience.

Guidelines

Touching on the guidelines for PrEP use, which is also a recommendation from the WHO, Dr Ayisi Addo said it was necessary for people to avoid its abuse because some components of PrEP medication were also in ART, so if people abused PrEP now and they later got HIV, the medication might not be effective on them due to drug resistance.

"As you continue to create drug resistance in the general population, you are reducing the efficacy of the drug.

 That is why PrEP use is not widespread, and we are going to regulate its use to minimise abuse since our epidemic context is different from that of other countries," he explained.