Awareness of and positive attitudes toward HIV pre-exposure prophylaxis among reproductive-aged women in Ghana: A multilevel analysis of the 2022 Demographic and Health Survey

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is an effective biomedical intervention for preventing HIV acquisition. Using nationally representative data from Ghana, this study examined the factors associated with awareness of and positive attitudes toward PrEP among women of reproductive age. METHODS: The study utilised nationally representative data from the 2022 Ghana Demographic and Health Survey, with a weighted sample of 13,980 women. The outcome variable was awareness of and positive attitudes toward PrEP, assessed based on whether respondents had heard of PrEP and approved of people taking it to prevent acquiring HIV. Data analysis was conducted using Stata 18, employing a multilevel logistic regression model to examine factors associated with awareness of and positive attitudes toward PrEP. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: Overall, 12.1% (95% CI: 11.1-13.3) of women were aware of PrEP and had positive attitudes toward it. The Ahafo region had the highest proportion of women with awareness of and positive attitudes toward PrEP (21.1% [95% CI: 15.7-27.7]), whereas the Savannah region had the lowest (7.2% [95% CI: 5.3-9.9]). Women with two or more sexual partners had lower odds of being aware of and having positive attitudes toward PrEP (aOR = 0.51, 95% CI: 0.28-0.96) than those with no partner. Women aged 25-29 (aOR = 1.75, 95% CI: 1.28-2.40), 30-34 (aOR = 1.61, 95% CI: 1.14-2.27), 35-39 (aOR = 1.69, 95% CI: 1.22-2.32), and 40-44 (aOR = 1.48, 95% CI: 1.03-2.12) had higher odds of awareness of and positive attitudes toward PrEP than women aged 15-19 years. Also, higher odds of awareness of and positive attitudes toward PrEP were observed among women who had heard about other sexually transmitted infections (STIs) (aOR = 1.79, 95% CI: 1.40-2.28), had secondary (aOR = 1.34, 95% CI: 1.06-1.70) and higher education (aOR = 3.27, 95% CI: 2.35-4.55), and listened to radio (aOR = 1.20, 95% CI: 1.01-1.43), compared with those who have not heard of STIs, those with no education, and those who did not listen to the radio, respectively. Additionally, women from Central (aOR = 3.28, 95% CI: 1.76-6.12), Volta (aOR = 3.28, 95% CI: 1.63-6.62), Western North (aOR = 2.59, 95% CI: 1.26-5.29), Ahafo (aOR = 5.02, 95% CI: 2.54-9.91), Bono (aOR = 2.87, 95% CI: 1.37-6.02), Bono East (aOR = 2.87, 95% CI: 1.56-5.26), Oti (aOR = 5.64, 95% CI: 3.06-10.39), Northern (aOR = 2.47, 95% CI: 1.10-5.51), Upper East (aOR = 4.17, 95% CI: 2.05-8.50), and Upper West (aOR = 3.62, 95% CI: 1.85-7.08) regions had higher odds of awareness of and positive attitudes toward PrEP than those in the Western region. CONCLUSION: About 1 in 10 women in Ghana were aware of PrEP and held positive attitudes toward it. The factors associated with awareness of and positive attitudes toward PrEP included women's age, educational level, number of sexual partners, listening to the radio, hearing about other STIs, and geographical regions. Policymakers and healthcare providers should focus on interventions that address regional inequalities and barriers to PrEP awareness and facilitate uptake to strengthen HIV prevention efforts in Ghana.