ArticleGlobal health, science and practice2024
Health System Factors Influencing the Integration of Pre-Exposure Prophylaxis into Antenatal and Postnatal Clinic Services in Cape Town, South Africa.
Article in Global health, science and practice, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Article
- A rapid qualitative analysis of health care worker and community focus groups on determinants and implementation strategies for long-acting PrEP in antenatal and postpartum settings in Kenya.Discover health systems · 2026Article
- Preference for Service Delivery for Long-Acting Pre-exposure Prophylaxis for HIV Infection Among Pregnant and Breastfeeding Women in South Africa and Botswana.AIDS and behavior · 2025Article
- Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experiment.AJOG global reports · 2025Article
- Exploring resource availability for nurses implementing HIV prevention guidelines in primary healthcare facilities.Health SA = SA Gesondheid · 2025Article
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Authors and funding
10 authors.
Funding
Abstract
introductionOral pre-exposure prophylaxis (PrEP) is an effective and safe option to prevent HIV acquisition and vertical HIV transmission in pregnant and breastfeeding women. Understanding health system factors influencing the integration of PrEP into care for pregnant and breastfeeding women is key to increasing access. We explored managers' and health care workers' (HCWs) experiences with integrating PrEP into antenatal care and postnatal care services in primary health care clinics in Cape Town, South Africa.
methodsThis exploratory qualitative study used codebook thematic analysis, where HCWs were purposively, heterogeneously sampled from an implementation science study. Semistructured individual interviews were conducted with 9 managerial-level staff, and 3 focus group discussions were conducted with HCWs (nurses, midwives, and HIV counselors) providing PrEP (6-7 HCWs per group) between November 2022 and January 2023 (N=28). Interview guides covered health system facilitators, barriers, and recommendations. The Health Systems Dynamics framework guided data analysis and presentation of results.
resultsPrEP integration into antenatal care services was described as acceptable and feasible; however, changes to HIV testing policy and indicators in breastfeeding women are needed to integrate PrEP into postnatal clinics, together with identification of mother and baby as a dyad in visits. Results showed that supportive policies facilitated wider, simplified PrEP provision. The availability and accessibility of prescribing nurses and lay HIV counselors, PrEP (both within facilities and in communities), and information about PrEP for implementers and pregnant and breastfeeding women will be pivotal to facilitating integration.
conclusionFacilitators for PrEP integration include task-shifting PrEP education and identification of women for PrEP initiation to HIV counselors, changes to national guidelines defining who can prescribe PrEP, revision and integration of PrEP training for HCWs, community-level interventions for PrEP demand creation and stigma reduction, and provision of differentiated PrEP delivery options.
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