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

Abstract

BackgroundScale-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.MethodsWe 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.ResultsWe 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.ConclusionsStandardized 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.

Atuação da enfermagem na atenção à saúde de parceiros sorodiferentes ao HIV – revisão integrativa

“…Las acciones preventivas identificadas forman parte de la prevención combinada, es decir, estrategias que pueden ser adoptadas simultáneamente (4) . Son conductas basadas en la pareja aunque haya estrategias preventivas individuales, como el asesoramiento (individual y con los parejos) que puede ser asociado a otras conductas como las consultas de enfermería, antes y después de las pruebas rápidas; suministro de PrEP y PEP para la pareja VIH negativo; tratamiento con antirretrovirales de PVHIV; además de las actividades de educación en salud para concientización de las parejas y de su red familiar (4,20) .…”

The experience of healthcare workers to HIV pre-exposure prophylaxis (PrEP) implementation in low- and middle-income countries: a systematic review and qualitative meta-synthesis

“…The studies included in this review also demonstrated the structural barriers at the provider level. HCWs, as the key population in the delivery of PrEP, their knowledge, attitudes, and concerns were determinants of the successful implementation of PrEP ( 49 , 50 ). However, the findings showed that HCWs’ knowledge of PrEP should be strengthened, as they were unclear on how to accurately prescribe PrEP, and even failed to differentiate PrEP and PEP ( 30 ).…”

“Take services to the people”: strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda

“…Each participant took part in a single in-person qualitative interview guided by a semi-structured discussion guide (Additional file 1). The guide was developed collaboratively by the research team based on literature reviews, previous experiences working with PWUD and PWID populations in other settings, and knowledge of existing PrEP and harm reduction service delivery models and programs [19][20][21][22][23][24]. Participant interviews covered: (1) drug use experiences, (2) harm reduction knowledge and experiences, (3) HIV risk and risk perception, (4) knowledge and use of oral PrEP, and (5) perspectives of COVID-19 mitigation measures.…”