Opportunities and barriers for delivering PrEP service beyond public healthcare facilities to young Men in Rural South Africa: A Cross-sectional Qualitative study
1
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
2
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
3
Institute for Health & Aging, School of Nursing, University of California, San Francisco, United States
4
Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
5
RTI International, California, United States
6
Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
7
Division of Prevention Science, Department of Medicine, University of California, San Francisco, United States
Popul. Med. 2026;8(Supplement Supplement 1):A1767
ABSTRACT
BACKGROUND:
Young men in South Africa (SA) face socio-cultural and health service barriers that limit use of public primary healthcare and engagement with HIV prevention, including pre-exposure prophylaxis (PrEP) 1-4. Although often overlooked, heterosexual young men are important in sustaining HIV transmission, highlighting the need for tailored service delivery 5-6. This study examined opportunities and implementation factors for young men in a rural South African setting.
METHODS:
We conducted a cross-sectional qualitative study in rural Bushbuckridge, SA. We leveraged existing relationships and snowball sampling to recruit 25 health system and civil society stakeholders for key informant interviews; 13 young men aged 18–30 years, including those with and without prior PrEP experience, for in-depth interviews; and 6 additional young men for focus group discussions. Using rapid template analysis guided by the Consolidated Framework for Implementation Research (CFIR) 7-8, we examined factors shaping implementation across five non-facility PrEP delivery models: pharmacy, private clinics, nurse outreach, community health worker (CHW), and traditional health practitioner.
RESULTS:
Six CFIR constructs emerged. Mission alignment and access to knowledge facilitated implementation, while laws and policies, relational connections, stakeholder relationships, and compatibility varied in influence. Providers with prescription authority integrated PrEP easily, while others were restricted to providing specific services. Relationships supported service coordination but were limited to general health services and underused for PrEP. Most models showed recipient-centeredness, offering some sexual and reproductive, and HIV services of interest to young men, yet barriers for young men use of model included cost, confidentiality, and narrow scope of services. Confidential, discreet delivery was critical in most models but limited in the CHW model.
CONCLUSIONS:
The five models offer promise for expanding PrEP access for young men in rural South Africa. However, achieving this potential requires policy adaptation, regulatory alignment, and targeted investments to address structural and system-level barriers.
Young men in South Africa (SA) face socio-cultural and health service barriers that limit use of public primary healthcare and engagement with HIV prevention, including pre-exposure prophylaxis (PrEP) 1-4. Although often overlooked, heterosexual young men are important in sustaining HIV transmission, highlighting the need for tailored service delivery 5-6. This study examined opportunities and implementation factors for young men in a rural South African setting.
METHODS:
We conducted a cross-sectional qualitative study in rural Bushbuckridge, SA. We leveraged existing relationships and snowball sampling to recruit 25 health system and civil society stakeholders for key informant interviews; 13 young men aged 18–30 years, including those with and without prior PrEP experience, for in-depth interviews; and 6 additional young men for focus group discussions. Using rapid template analysis guided by the Consolidated Framework for Implementation Research (CFIR) 7-8, we examined factors shaping implementation across five non-facility PrEP delivery models: pharmacy, private clinics, nurse outreach, community health worker (CHW), and traditional health practitioner.
RESULTS:
Six CFIR constructs emerged. Mission alignment and access to knowledge facilitated implementation, while laws and policies, relational connections, stakeholder relationships, and compatibility varied in influence. Providers with prescription authority integrated PrEP easily, while others were restricted to providing specific services. Relationships supported service coordination but were limited to general health services and underused for PrEP. Most models showed recipient-centeredness, offering some sexual and reproductive, and HIV services of interest to young men, yet barriers for young men use of model included cost, confidentiality, and narrow scope of services. Confidential, discreet delivery was critical in most models but limited in the CHW model.
CONCLUSIONS:
The five models offer promise for expanding PrEP access for young men in rural South Africa. However, achieving this potential requires policy adaptation, regulatory alignment, and targeted investments to address structural and system-level barriers.
| eISSN: | 2654-1459 |
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