"We've Got Our Own Beliefs, Attitudes, Myths": A Mixed Methods Assessment of Rural South African Health Care Workers' Knowledge of and Attitudes Towards PrEP Implementation.
Emmanuella Ngozi AsaborElle LettAnthony MollSheela V ShenoiPublished in: AIDS and behavior (2021)
South Africa maintains the world's largest HIV prevalence, accounting for 20.4% of people living with HIV internationally. HIV Pre-exposure prophylaxis (PrEP) has demonstrated efficacy; however, there is limited data on PrEP implementation in South Africa, particularly in rural areas. Using grounded theory analysis of semi-structured interviews and exploratory factor analyses of structured surveys, this mixed methods study examines healthcare workers' (HCWs)' beliefs about their patients and the likelihood of PrEP uptake in their communities. The disproportionate burden of HIV among Black South Africans is linked to the legacy of apartheid and resulting disparities in wealth and employment. HCWs in our study emphasized the importance of addressing these structural barriers, including increased travel burden among men in the community looking for work, poor transportation infrastructure, and limited numbers of highly skilled clinical staff in their rural community. HCWs also espoused a vision of PrEP that prioritizes women due to perceived constraints on their sexual agency, and that minimizes the impact of HIV-related stigma on PrEP implementation. However, HCWs' additional concerns for risk compensation may reflect dominant social mores around sexual behavior. In recognition of HCWs' role as both informants and community members, implementation scientists should invite local HCWs to partner as early as the priority-setting stage for PrEP interventions. Inviting leadership from local HCWs may increase the likelihood of delivery plans that account for unique local context and structural barriers researchers may otherwise struggle to uncover.
Keyphrases
- men who have sex with men
- hiv positive
- hiv testing
- mental health
- healthcare
- south africa
- primary care
- quality improvement
- risk factors
- physical activity
- hiv aids
- antiretroviral therapy
- end stage renal disease
- social support
- hiv infected
- ejection fraction
- human immunodeficiency virus
- hepatitis c virus
- mental illness
- depressive symptoms
- prognostic factors
- chronic kidney disease
- newly diagnosed
- study protocol
- cross sectional
- clinical trial
- deep learning
- polycystic ovary syndrome
- insulin resistance
- adipose tissue
- artificial intelligence