Multi-Dimensional Predictors of HIV PrEP Knowledge, PrEP Acceptability and HIV Testing among Adolescents and Young Adult Men in Ghana

Background: Research on sexuality and HIV prevention among adolescents and young adults (AYA) men are limited despite recent progress in HIV prevention and the low generalized HIV levels in Ghana. Objectives: To assess the prevalence of HIV PrEP Knowledge, PrEP Acceptability, HIV Testing, and to identify multi-dimensional factors predicting the knowledge and acceptability of PrEP coupled with HIV testing engagement among adolescents and young adult (AYA) males aged 15 - 24 years in Ghana. Methods: The men’s dataset of the 2022 Ghana Demographic and Health Survey (n = 2453) were utilized for this study. Descriptive characteristics were summarized using frequencies and proportions. Three sets of multivariate logistic regression models examined the relationship between independent (socio-demographics) and dependent variables (HIV PrEP knowledge, HIV PrEP Acceptability, and HIV testing). Results: Among participants aged 15 - 24 years in Ghana, only 15.3% had knowledge of pre-exposure prophylaxis (PrEP), with a low acceptability rate of 32.1%, while merely 8.5% had undergone HIV testing, despite a 49% rate of sexual activity. The logistic regression results suggest significantly lesser odds of HIV PrEP knowledge among participants from the Volta (AOR = 0.21, 95% CI = 0.08 - 0.58, p = 0.002), Eastern (AOR = 0.23, 95% CI = 0.10 - 0.57, p = 0.01), Western North (AOR = 0.20, 95% CI = 0.08 - 0.49, p ＜ 0.001), and Bono East (AOR = 0.29, 95% CI = 0.13 - 0.66, p = 0.003) regions. Conversely, there were significantly higher odds of HIV PrEP knowledge among the widowed/separated/divorced (AOR = 3.57, 95% CI = 1.30 - 9.85, p = .014), and the participants with a higher education (AOR = 2.60, 95% CI = 1.29 - 5.26, p = 0.008). Furthermore, there were significantly lower odds of HIV testing among participants from the Central region (AOR = 0.37, 95% CI = 0.16 - 0.83, p = 0.016); whereas those aged between 20 - 24 years old (AOR = 2.11, 95% CI = 1.41 - 3.17, p ＜ 0.001), had at least a secondary education (AOR = 2.68, 95% CI = 1.23 - 5.85, p = 0.013), a higher education (AOR = 7.07, 95% CI = 2.94 - 16.99, p ＜ 0.001), and sexually active (AOR = 1.99, 95% CI = 1.37 - 2.90, p ＜ 0.001) had significantly higher odds of HIV testing. Conclusion: Region, marital status, employment status, religion, and recent sexual activity appear to be relevant predictors of HIV PrEP knowledge, HIV PrEP acceptability, and HIV testing among the AYA population in Ghana; whereas higher education emerged as a sole strongly significant predictor of both HIV PrEP knowledge and HIV testing respectively. Conclusively, safer sex education among young men with no secondary or higher education residing in regions with lower HIV PrEP awareness and HIV testing should be prioritized. Likewise, existing HIV prevention initiatives in Ghana should consider these empirically significant multidimensional predictors as a valuable guide.