Factors to Be Considered for Integration of HIV Pre-Exposure Prophylaxis into Primary Health Services in North West Province, South Africa

Abstract

Aim: The study aimed to explore the factors that should be considered for integrating HIV pre-exposure prophylaxis (PrEP) into primary health care services in Matlosana, North West Province. This is based on literature that shows that despite national progress in rolling out HIV (PrEP) by the World Health Organisation’s endorsement in 2015 and its formal adoption by South Africa in 2016, significant challenges persist in ensuring equitable access, sustained use, and effective service integration at the primary care level. Furthermore, no studies have focused on the factors to consider for integrating HIV PrEP into primary healthcare services in Matlosana, North West Province. Setting: The study was conducted in Community Health Centres in Matlosana, North West Province, South Africa. Research Methodology: This study employs a two-phase sequential multi-method design, comprising a scoping review and a qualitative component. In Phase 1, a scoping review of literature guided by Arksey and O’Malley and the Joanna Briggs framework of scoping reviews was conducted. Five databases were searched for studies published between 2012 and 2022. In Phase 2, a qualitative component consisting of four focus group discussions was conducted among purposively selected Primary Health Care (PHC) Nurses. The qualitative data were analysed using thematic analysis. Results: Findings from the scoping review and the qualitative component were merged and compared. The six emergent themes are Overall feasibility, Key facilitators, Importance of awareness, Role of stigma, Recommendations, and Specific contextual factors. To systematically assess how well this integration works in real- world settings, we applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, which examines RE-AIM. Recommendations for clinical practice, education and further research were formulated such as investment in resources, and compliance with systems/guidelines.