Exploring resource availability for nurses implementing HIV prevention guidelines in primary healthcare facilities

Background: Pre-exposure prophylaxis (PrEP) lowers new human immunodeficiency virus (HIV) infections among individuals at risk; however, its uptake in South Africa is hindered by resource limitations within public health facilities. This occurs despite the established PrEP guidelines to promote its use. Aim: This study aimed to explore the availability of resources that support nurses in implementing the PrEP guidelines in Johannesburg’s primary health settings. Setting: Four primary healthcare settings in sub-districts A and E of the City of Johannesburg, South Africa, were used to conduct the study. Methods: A qualitative exploratory design with an interpretive approach was used to gather insights into the availability of resources for implementation of PrEP guidelines. Donabedian’s framework was used to assess implementing PrEP guidelines looking at the structure, process and outcomes linked to resource availability. Data were gathered from 19 nurses in four primary healthcare facilities via semi-structured interviews and analysed using the thematic analysis method. Results: Three overarching themes emerged as barriers to effective PrEP implementation: (1) structural inadequacies; (2) healthcare system processes and support; and (3) unclear performance tracking. Both barriers and facilitators were identified to have an impact on the implementation of PrEP while highlighting the need for the strengthening of the healthcare system in HIV prevention success. Conclusion: The study highlights critical resource limitations hindering PrEP implementation. It underlines the urgent need for improved physical infrastructure, additional human resources and robust data management systems. Contribution: The study emphasises the need for policymakers to strengthen infrastructure and human resources to minimise service delays and inefficiencies, ultimately reducing healthcare costs by enhancing PrEP uptake and retention.