Working for PrEP acceptance in SA community health-worker programme

HIV Pre-Exposure Prophylaxis (PrEP) has been proven to reduce the risk of HIV infection among consistent HIV-negative users to nearly zero. Despite these benefits, oral PrEP awareness and uptake in South Africa is relatively low.

Community-based strategies are known to get information and services to where they are most needed. The Bill & Melinda Gates Foundation (BMGF) is funding implementation research projects to champion community-based PrEP service delivery.

Genesis Analytics, on behalf of the Gates Foundation, conducted a qualitative landscape analysis of the policy and implementation environment for community-based services in South Africa to inform the sustainable planning and implementation of their investments.

We primarily employed inductive thematic analyses derived from desktop reviews, key informant interviews and focus group discussions with technical experts.

Our research uncovered structural and implementation barriers impeding the successful expansion of the PrEP programme to communities. It did, however, reveal opportunities to systematically integrate PrEP into routine community-based services through the strategic use of appropriately trained, remunerated and empowered community health workers (CHWs).

These findings have prompted BMGF to reconsider the viability of integrating PrEP into the current CHW programme, without substantial shifts in governance and management.