Ntimani Junior M, Mokoena-de Beer Andile G, Phetlhu Deliwe R
Nursing Sciences Department, School of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Health SA. 2025 Aug 21;30:3084. doi: 10.4102/hsag.v30i0.3084. eCollection 2025.
Pre-exposure prophylaxis (PrEP) lowers new human immunodeficiency virus (HIV) infections among individuals at risk; however, its uptake in South Africa is hindered by resource limitations within public health facilities. This occurs despite the established PrEP guidelines to promote its use.
This study aimed to explore the availability of resources that support nurses in implementing the PrEP guidelines in Johannesburg's primary health settings.
Four primary healthcare settings in sub-districts A and E of the City of Johannesburg, South Africa, were used to conduct the study.
A qualitative exploratory design with an interpretive approach was used to gather insights into the availability of resources for implementation of PrEP guidelines. Donabedian's framework was used to assess implementing PrEP guidelines looking at the structure, process and outcomes linked to resource availability. Data were gathered from 19 nurses in four primary healthcare facilities via semi-structured interviews and analysed using the thematic analysis method.
Three overarching themes emerged as barriers to effective PrEP implementation: (1) structural inadequacies; (2) healthcare system processes and support; and (3) unclear performance tracking. Both barriers and facilitators were identified to have an impact on the implementation of PrEP while highlighting the need for the strengthening of the healthcare system in HIV prevention success.
The study highlights critical resource limitations hindering PrEP implementation. It underlines the urgent need for improved physical infrastructure, additional human resources and robust data management systems.
The study emphasises the need for policymakers to strengthen infrastructure and human resources to minimise service delays and inefficiencies, ultimately reducing healthcare costs by enhancing PrEP uptake and retention.
暴露前预防（PrEP）可降低高危人群中新发人类免疫缺陷病毒（HIV）感染率；然而，南非公共卫生设施的资源限制阻碍了其推广。尽管已有既定的PrEP指南来促进其使用，但这种情况仍在发生。
本研究旨在探索在约翰内斯堡的基层医疗环境中支持护士实施PrEP指南的资源可用性。
南非约翰内斯堡市A和E分区的四个基层医疗点被用于开展本研究。
采用定性探索性设计和解释性方法，以深入了解实施PrEP指南的资源可用性。使用Donabedian框架评估PrEP指南的实施情况，考察与资源可用性相关的结构、过程和结果。通过半结构化访谈从四个基层医疗机构的19名护士收集数据，并采用主题分析法进行分析。
出现了三个总体主题，成为有效实施PrEP的障碍：（1）结构不足；（2）医疗系统流程与支持；（3）绩效跟踪不明确。研究确定了阻碍因素和促进因素均对PrEP的实施产生影响，同时强调了加强医疗系统以实现HIV预防成功的必要性。
该研究突出了阻碍PrEP实施的关键资源限制。强调迫切需要改善物理基础设施、增加人力资源和建立强大的数据管理系统。
该研究强调政策制定者需要加强基础设施和人力资源，以尽量减少服务延误和低效率，最终通过提高PrEP的接受率和持续使用率来降低医疗成本。
