Exploring Healthcare Providers' Perspectives and Experiences in the Provision of Oral PrEP for Adolescent Girls and Young Women in a Sub-District in the City of Johannesburg, South Africa

Abstract

Introduction In South Africa, adolescent girls and young women (AGYW) face a significantly higher risk of HIV infection, driven by factors such as poverty, gender inequality, and limited access to healthcare. Oral pre-exposure prophylaxis (PrEP) is a proven preventative method, reducing HIV transmission risk by over 90% when used consistently. Despite its efficacy, AGYW face significant challenges in PrEP uptake and adherence. Healthcare providers (HCPs) play a pivotal role in PrEP delivery, but their perspectives remain underexplored. Methods This secondary qualitative analysis builds on the 2018 EMPOWER trial, which explored PrEP provision with adherence support clubs for AGYW aged 16–24 in a sub-district (Region F), Johannesburg. In-depth interviews were conducted with nine (n=9) HCPs (counsellors, a clinician, a nurse, a pharmacist, and community health workers), including Wits RHI project staff, who worked directly with AGYW in Hillbrow. A semi-structured interview guide explored HCPs’ views on AGYW’s HIV risks, PrEP benefits, and service delivery barriers. Data were analysed using inductive and deductive coding, guided by the HBM, with NVivo and Excel for thematic organisation. Results HCPs perceived high HIV susceptibility among AGYW due to risky behaviours like unprotected sex and relationships with “blessers” (perceived susceptibility), yet noted AGYW often underestimate HIV risk due to misconceptions (perceived barriers). They viewed PrEP as empowering for AGYW in contexts of limited sexual autonomy (perceived benefits), but key barriers included stigma, partner disapproval, and misinformation about PrEP’s safety. Primary facilitators included peer support through EMPOWER clubs and tailored counselling (cues to action, self-efficacy). HCPs also underscored their need for enhanced counselling training to increase their self-efficacy in delivering adolescent-responsive PrEP services, emphasising their pivotal role in effective implementation. v Conclusion HCPs’ perspectives underscore the need for multifaceted strategies to improve PrEP use and adherence among AGYW. HCPs alongside community health workers (CHWs), health promoters and counsellors can strengthen counselling to address stigma and misconceptions, refer AGYW to facilities or mobile clinics with oral PrEP and other alternatives, and promote peer and partner involvement through adherence clubs. Enhanced training is critical to optimise adolescent-responsive service delivery and reduce HIV risk for AGYW in South Africa.