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. 2025 Apr;29(4):1216-1227.
doi: 10.1007/s10461-024-04596-5. Epub 2025 Jan 9.

Experiences with Oral Pre-Exposure Prophylaxis (PrEP) Service Delivery and Use Among Adolescent Girls and Young Women (AGYW) in Routine Primary Care Settings, South Africa

Catherine E Martin  1 , Lorrein S Muhwava  2 , Siphokazi Dada  2 , Fiona Scorgie  2 , Saiqa Mullick  2
Affiliations

Experiences with Oral Pre-Exposure Prophylaxis (PrEP) Service Delivery and Use Among Adolescent Girls and Young Women (AGYW) in Routine Primary Care Settings, South Africa

Catherine E Martin et al. AIDS Behav. 2025 Apr.

Abstract

In South Africa, oral PrEP was included in national guidelines as part of a combination HIV prevention package for adolescent girls and young women (AGYW) in 2017. Understanding their experiences of accessing and using PrEP is necessary to evaluate and improve PrEP service delivery approaches. This descriptive study explored AGYW's knowledge and understanding of PrEP, their experiences and influences on PrEP access and use in real world settings in South Africa. We conducted 44 in-depth interviews with female PrEP users (15-24 years) enrolled in Project PrEP. Interviews were audio recorded and transcribed for analysis using thematic analysis procedures. Participants reported positive experiences and overall satisfaction with accessing health services (i.e., youth-friendly clinic spaces, friendly and non-judgemental staff, privacy during consultations). Distance from the clinic, long queues, negative provider attitudes, and occasional stock-outs were key health service barriers to accessing PrEP. Individual motivating factors to continued PrEP use included creating daily pilltaking routines and the goal to remain HIV negative, while barriers included pill fatigue, frequent clinic visits, and side-effects. Positive relationships with partners and family facilitated disclosure of PrEP use, while stigma was identified as a community barrier to accessing PrEP services. Our study highlights AGYWs' experiences with PrEP access and use in a real-world setting. Facilitators and barriers identified in this study can be leveraged to strengthen efforts to support young women and ensure effective PrEP use. The findings also contribute to the development of appropriate service delivery.

Keywords: Adolescent girls and young women (AGYW); HIV prevention; Health service delivery; PrEP use; Pre-exposure Prophylaxis (PrEP); Socio-Ecological Model (SEM); South Africa.

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Conflict of interest statement

Declarations. Ethics Approval and Consent to Participate: The study protocol was reviewed and approved by the Human Research Ethics Committee of the University of the Witwatersrand (M180806) and the World Health Organization (WHO) Ethics Research Committee (Wits-PrEP-AGYW). Additional permissions were obtained from the district and provincial research committees in the study clusters as required. All participants provided their written informed consent to participate in this study. Participants who were under the age of 18 years old were required to complete an Assessment of Understanding questionnaire prior to signing an informed consent form. Consent for Publication: Not applicable. Competing Interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Socio-ecological model of factors influencing PrEP access and use among AGYW in South Africa
See this image and copyright information in PMC

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