Improving access to pre-exposure prophylaxis for adolescent girls and young women: recommendations from healthcare providers in eastern Zimbabwe

• Published in: BMC infectious diseases Vol. 22; no. 1; pp. 399 - 10
• Main Authors: Skovdal, Morten, Magoge-Mandizvidza, Phyllis, Dzamatira, Freedom, Maswera, Rufurwokuda, Nyamukapa, Constance, Thomas, Ranjeeta, Mugurungi, Owen, Gregson, Simon
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23.04.2022; BioMed Central; BMC
• Subjects: Adolescent; Adolescents; Anti-HIV Agents - therapeutic use; Disease prevention; Epidemics; Female; Girls; Health aspects; Health care; Health care facilities; Health facilities; Health Personnel; Health risks; Health services; HIV; HIV infection; HIV Infections - drug therapy; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Interviews; Management; Medical personnel; Network analysis; Pre-Exposure Prophylaxis; PrEP; Prevention; Prophylaxis; Risk factors; Sexually transmitted diseases; Social aspects; Urban health; Young adults; Young women; Zimbabwe; Zimbabwe; Africa; Prevention; Zimbabwe; PrEP; HIV; Health services
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-022-07376-5

In sub-Saharan Africa, adolescent girls and young women (AGYW) are at high risk of acquiring HIV. A growing number of sub-Saharan African countries are beginning to avail pre-exposure prophylaxis, or PrEP, but with limited success. Unpacking strategies to overcome barriers to the uptake of PrEP is critical to prevent HIV amongst AGYW. This article explores health professionals' views and recommendations on what is required to increase uptake of PrEP. The study draws on interview data from 12 providers of HIV prevention services in eastern Zimbabwe. The healthcare providers were purposefully recruited from a mix of rural and urban health facilities offering PrEP. The interviews were transcribed and imported into NVivo 12 for thematic coding and network analysis. Our analysis revealed six broad strategies and 15 concrete recommendations which detail the range of elements healthcare providers consider central for facilitating engagement with PrEP. The healthcare providers called for: (1) PrEP marketing campaigns; (2) youth-friendly services or corners; (3) improved PrEP delivery mechanisms; (4) improvements in PrEP treatment; (5) greater engagement with key stakeholders, including with young people themselves; and (6) elimination of costs associated with PrEP use. These recommendations exemplify an awareness amongst healthcare providers that PrEP access is contingent on a range of factors both inside and outside of the clinical setting. Healthcare providers are at the frontline of the HIV epidemic response. Their community-embeddedness, coupled with their interactions and encounters with AGYW, make them well positioned to articulate context-specific measures for improving access to PrEP. Importantly, the breadth of their recommendations suggests recognition of PrEP use as a complex social practice that requires integration of a combination of interventions, spanning biomedical, structural, and behavioural domains.