Preparedness of Primary Health Care Clinic (PHCC) Providers for the Provision of Oral Pre-exposure Prophylaxis (PrEP) to Adolescent Girls and Young Women (AGYW): Experiences from KwaZulu-Natal, South Africa

About two-thirds of all HIV infections in 2024 were in sub-Saharan Africa, where adolescent girls and young women (AGYW) bear a disproportionate burden. Daily oral pre-exposure prophylaxis (PrEP) offers an HIV prevention option for AGYW at high risk who are unable to negotiate safer sex with male partners. Primary health care clinics (PHCCs) staffed by nurses are an important access point for health services, including antiretroviral treatment, family planning, and antenatal care. Effective delivery of new and existing services depends on the preparedness and acceptability of interventions among health care workers (HCWs). This study explored the preparedness of rural PHCC HCWs in South Africa to deliver PrEP to AGYW, in anticipation that PrEP would become widely available at PHCCs in 2020. Twelve in-depth interviews were conducted with HCWs from all six PHCCs in a rural sub-district. Knowledge, attitudes, and experiences in delivering PrEP to AGYW were explored to identify key facilitators and barriers to implementation, in anticipation of widescale oral PrEP roll-out in public-sector facilities. Providers recognised AGYW's elevated HIV risk and viewed PHCCs as suitable PrEP distribution sites, noting opportunities to leverage existing contraceptive service infrastructure. However, several barriers emerged, including limited PrEP knowledge, inexperience in PrEP provision, and concerns about logistics for additional service delivery within existing staff and infrastructure constraints. This study highlights the need for targeted HCW training and simplified PrEP guidelines to support PrEP provision by HCWs in PHCCs to AGYW in this rural sub-district.