Abstract / Summary
Adolescent girls and young women (AGYW) in Ghana face persistent barriers to HIV prevention, including limited uptake of HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP). While national policies support these tools, implementation gaps remain, particularly among young women navigating socio-cultural and structural constraints. This study aimed to identify multilevel barriers to HIVST and PrEP uptake and to co-design contextually grounded implementation strategies through participatory engagement. We conducted a co-creation workshop with adolescent girls and young women ( n = 10) and community interest-holders ( n = 5) from Greater Accra and Eastern Regions of Ghana. Data sources included audio-recorded discussions, facilitator field notes, Nominal Group Technique rankings, and intervention prototypes. Transcripts were analyzed using thematic analysis with iterative coding and consensus refinement. Identified barriers were mapped across individual, interpersonal, socio-cultural, and structural levels. Co-created strategies were synthesized and aligned with the manifestations of barriers. Four higher-order barrier domains were identified: [1] cultural and religious norms that moralized female sexuality and framed HIV prevention as inappropriate behavior; [2] limited actionable knowledge and procedural uncertainty regarding HIVST and PrEP; [3] fear and stigma operating through anticipatory emotional distress, relational scrutiny, and confidentiality concerns; and [4] structural constraints, including inconsistent service availability, financial barriers, geographic inequities, and health system practices. Participants co-designed multilevel implementation strategies, including culturally grounded storytelling, faith-leader engagement, peer-led WhatsApp-based education tailored to development stage, anonymous digital support mechanisms, and decentralized community-based service-delivery pathways. Participants emphasized that educational content should be tailored to different developmental stages, reflecting variations in prevention needs, relationship contexts, and communication preferences. HIVST and PrEP uptake among AGYW in Ghana is shaped by intersecting socio-cultural, interpersonal, and structural determinants. The co-developed strategies will inform a pilot phase to evaluate feasibility and acceptability and to refine approaches for broader scale-up. By grounding intervention design in lived experiences and structural realities, this study offers contextually specific guidance for strengthening HIV prevention implementation in Ghana.