Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 4:10:658826.
doi: 10.3389/fpubh.2022.658826. eCollection 2022.

Health Care Worker Perspectives of HIV Pre-exposure Prophylaxis Service Delivery in Central Uganda

Timothy R Muwonge  1 , Rogers Nsubuga  1 , Norma C Ware  2 , Monique A Wyatt  2 , Emily Pisarski  2 , Brenda Kamusiime  1 , Vicent Kasiita  1 , Grace Kakoola Nalukwago  1 , Charles Brown  1 , Agnes Nakyanzi  1 , Monica Bagaya  1 , Felix Bambia  1 , Timothy Ssebuliba  1 , Elly Katabira  3 , Peter Kyambadde  4   5 , Jared M Baeten  6   7 , Renee Heffron  6 , Connie Celum  6 , Andrew Mujugira  1 , Jessica E Haberer  2   8
Affiliations

Health Care Worker Perspectives of HIV Pre-exposure Prophylaxis Service Delivery in Central Uganda

Timothy R Muwonge et al. Front Public Health. .

Abstract

Background: Scale-up of HIV pre-exposure prophylaxis (PrEP) services in Uganda is ongoing. However, health care workers (HCWs) may not be aware of PrEP nor what offering this service entails. We explored the impact of standardized HCW training on the knowledge and perspectives of PrEP service delivery in Uganda.

Methods: We recruited HCWs from facilities that offered HIV-related services in Central Uganda. Using the Uganda Ministry of Health curriculum, we trained HCWs on PrEP services. We collected data about PrEP knowledge, preparedness, and willingness to deliver PrEP to multiple key populations before the training, immediately after the training, and >6 months later (exit). We additionally conducted 15 qualitative interviews after the exit survey. Quantitative data were analyzed by Fisher exact test, while qualitative interview data were analyzed inductively.

Results: We recruited 80 HCWs from 35 facilities in urban (N = 24, 30%), peri-urban (N = 30, 37%), and rural (N = 26, 33%) areas. Most HCWs were nurse counselors (N = 52, 65%) or medical/clinical officers (N = 15, 18%). Surveys indicated that awareness of PrEP increased after the training and remained high. Knowledge of PrEP (i.e., as an effective, short-term antiretroviral medication to use before HIV exposure for people at high risk) generally increased with training, but significant gaps remained, and knowledge decreased with time. Most HCWs recommended PrEP for female sex workers and HIV serodifferent couples, as well as other key populations. We observed increases in the number of HCW who felt their facility was prepared to cater for HIV prevention and provide PrEP, but this view was not universal. HCWs believed in PrEP effectiveness and embraced it as an additional HIV prevention method. Concerns included patient adherence and behavioral risk compensation. HCWs noted challenges in PrEP delivery in terms of inadequate clinic preparedness, infrastructure, staff capacity, and poor attitudes toward key populations by untrained health workers. They felt further training was needed to ensure a smooth scale-up of services without stigmatization.

Conclusions: Standardized training improved knowledge, willingness, and preparedness to offer PrEP services among most HCWs in Central Uganda. Ongoing training will be needed to optimize PrEP delivery services and expand delivery to levels needed for population-level impact.

Keywords: HIV prevention; PrEP training; Uganda; healthcare worker; serodiscordant couples; sub-Saharan Africa.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Chou R, Evans C, Hoverman A, Sun C, Dana T, Bougatsos C, et al. . Preexposure Prophylaxis for the Prevention of HIV Infection: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. (2019) 321:2214–30. 10.1001/jama.2019.2591 - DOI - PubMed
    1. Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O'Reilly KR, Koechlin FM, et al. . Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. Aids. (2016) 30:1973–83. 10.1097/QAD.0000000000001145 - DOI - PMC - PubMed
    1. WHO . Updated Recommendations on First-line and Second-line Antiretroviral Regimens and Post-exposure Prophylaxis and Recommendations on Early Infant Diagnosis of HIV: Interim Guidelines: Supplement to the 2016 Consolidated Guidelines on the use of Antiretroviral Drugs for Treating and Preventing HIV Infection. World Health Organization (2018). Available online at: https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51 (accessed November 11, 2020).
    1. Amico KR, Bekker LG. Global PrEP roll-out: recommendations for programmatic success. Lancet HIV. (2019) 6:e137–40. 10.1016/S2352-3018(19)30002-5 - DOI - PubMed
    1. Uganda MoH. Technical Guidance on Pre-Exposure Prophylaxis (PrEP) for Persons at High Risk of HIV in Uganda. Kampala, Uganda: Ministry of Health; (2016).