"We've Got Our Own Beliefs, Attitudes, Myths": A Mixed Methods Assessment of Rural South African Health Care Workers' Knowledge of and Attitudes Towards PrEP Implementation

Study-to-Clinic Transition and Daily Oral PrEP Access Experiences Among AGYW in Eastern Cape, South Africa: Insights from the Community PrEP Study

Adolescent girls and young women (AGYW) face a high HIV burden, while PrEP persistence often declines post-trial. Understanding access outside research settings is key to improving study-to-clinic transitions. This study explored AGYW's experiences accessing PrEP in public clinics after The Community PrEP Study (CPS) in Eastern Cape, South Africa, a 24-month behavioral intervention. AGYW referred to clinics post-study (June-November 2021) were interviewed on their transition experiences. Interviewers categorized participants as PrEP continuation, discontinuation, or non-presentation. The qualitative team iteratively coded transcripts, used matrix analysis and discussions to examine referral experiences, clinic access, and PrEP motivations. While most accepted the transition, many missed study support. Continuation was linked to clinic adaptation, while discontinuation stemmed from access barriers. Non-presentation resulted from logistical and privacy concerns. Recommendations included youth-friendly provider training, alternative PrEP pick-up options, and service integration. Provider engagement and training remain critical for optimizing PrEP access, even with long-acting modalities.Trial registration number NCT03977181. Date of registration: 6 June 2019 - retrospectively registered.

HIV Preexposure Prophylaxis Practice among Urban Female Sex Workers in Northwest Ethiopia: Using Generalized Structural Equation Modeling

BACKGROUND

Acquired immunodeficiency syndrome, caused by the human immunodeficiency virus, has remained a public health threat for the last decades with significantly high burden. Despite the introduction of various human immunodeficiency virus (HIV) prevention strategies targeting high-risk populations, including preexposure prophylaxis, there remains a notable gap in the literature regarding Pre-Exposure Prophylaxis (PrEP) practice among female sex workers (FSWs) in Ethiopia, particularly using advanced analytical methods like structural equation modeling. This study aimed to assess practice and associated factors of preexposure prophylaxis among urban female sex workers in Northwest Ethiopia.

METHODS

A cross-sectional study was carried out at organizations of Organizations for Social Service, Health Development, Mehabere Hiwot for Social Development, and African Network for the Prevention and Protection Against Child Abuse and Neglect that serve FSWs. Systematic random sampling technique was employed among 549 FSWs. An interviewer-administered questionnaire was used to collect the data. Generalized structural equation modeling was employed to identify factors associated with PrEP practice. As the mediation of effects was present, the direct, indirect, and total effects were determined. A final model was selected based on the statistical significance of the path coefficient.

RESULTS

In this study, the practice of preexposure prophylaxis was 28.00% with 95% CI = 25.34% to 32.72%. Thus, female sex workers with an education level of college and above had both direct and indirect positive effects on PrEP practice when mediated by knowledge, knowledge had both direct and indirect effects on PrEP practice when mediated by attitude. Whereas, FSWs who had duration of sex work for 3 to 5 years had only a positive direct effect on PrEP practice compared to those who were living in sex work for less than three years duration.

CONCLUSION

However, HIV remains a public health problem, and the practice of preexposure prophylaxis in this study was found to be low. FSWs having higher education levels, attitudes, and knowledge demonstrate a significantly positive effect on their likelihood to practice PrEP. They suggested enhancing their health outcomes and reducing the risk of HIV transmission. The result of this study was also significant for communities that are serving in a given organization targeting integrated HIV testing and counseling services among key populations.

Knowledge and attitudes of HIV pre-exposure prophylaxis among nurses in South Africa

BACKGROUND

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) has shown efficacy and effectiveness in populations who practise high-risk sexual activity. Nurses' knowledge and positive attitudes enhance PrEP implementation.

AIM

This study aimed to investigate the knowledge of and attitudes towards PrEP among nurses in primary health care facilities.

SETTING

The study was conducted in 10 health facilities that offer comprehensive services in Tshwane, South Africa.

METHODS

A cross-sectional survey assessed the knowledge of and attitudes towards PrEP among 114 nurses. Univariate, bivariate and logistic regressions were performed to estimate odds ratios and to determine whether age, sex and education had an association with the knowledge and attitudes.

RESULTS

Majority of the study sample consisted of female nurses (92.1%), and most respondents (68%) had moderate PrEP knowledge. Logistic regression showed that age and education were not associated with high level of knowledge. Pre-exposure prophylaxis was viewed negatively by 84.5% of the respondents. The odds of positive attitudes towards PrEP were 1.92 times higher among males than females (95% CI 0.54-6.83) and 1.24 times higher among nurses who had bachelor's degree than diploma holders (95% CI 0.51-3.01).

CONCLUSION

This study found that there is a need to strengthen the dissemination of information about PrEP, and nurses in South Africa require training to improve their knowledge of and attitudes towards PrEP.Contribution: The findings of the study add to the current knowledge base regarding PrEP access in the public healthcare system and it highlights gaps in the training of healthcare providers.

Health system opportunities and challenges for PrEP implementation in Kenya: A qualitative framework analysis

Background

As pre-exposure prophylaxis (PrEP) scales up in sub-Saharan Africa, governments and implementers need to understand how to best manage national programs. Kenya’s national PrEP program offers an opportunity to review elements of program success within the health system and evaluate the utility of a national implementation framework. We explored health system considerations for PrEP implementation to understand how Kenya’s national PrEP implementation priorities align with those of PrEP service providers, peer educators, and program or county managers.

Methods

We conducted twelve key informant interviews (KII) and nine focus group discussions (FGDs) with PrEP program and county managers (n = 12), peer educators (n = 44), and PrEP service providers (n = 48). We recruited participants across a variety of cadres and experiences with PrEP programs. KIIs and FGDs focused on PrEP service delivery and program implementation. Data were collected by trained study staff, audio recorded, translated into English, and transcribed. We used framework analysis methods to systematically apply Kenya’s 2017 National PrEP Implementation Framework to the data and summarized findings according to the seven Implementation Framework domains.

Results

All respondents emphasized the important role of communication, coordination, training, and leadership in PrEP implementation. PrEP service providers and program and county managers highlighted the importance of efficient data collection and utilization, and improved resource allocation. Commodity security and research, while key elements of the PrEP Implementation Framework, were less commonly discussed, and research was less prioritized by respondents. Respondents highlighted the importance of coordinated PrEP service delivery across sites and programs to improve overall client experiences.

Conclusion

In the context of a nationally-scaled PrEP program, PrEP service providers, peer educators, and program and county managers value strong leadership, close coordination of services across sites, and expedient use of data to improve strategies and services. Kenya’s PrEP Implementation Framework aligns closely with the priorities of individuals involved in PrEP service delivery and management, and provides a comprehensive overview of health system considerations for effective implementation of a PrEP program at scale.