Perceptions of primary healthcare workers on injectable HIV Pre- Exposure Prophylaxis (PrEP) in campus health clinics in KwaZulu- Natal, South Africa

Abstract

Background: HIV remains a significant public health challenge in South Africa, particularly among young people aged 15-24 years in KwaZulu-Natal. While oral pre exposure prophylaxis (PrEP) has been available since 2016, adherence challenges limit its effectiveness. Long-acting injectable PrEP (cabotegravir) offers a promising alternative, but successful implementation depends on the perceptions and readiness of primary healthcare (PHC) workers who deliver these services in campus health clinics. Aim: This study aimed to explore PHC workers' perceptions of the implementation and use of HIV injectable PrEP in campus health clinics at a public university in KwaZulu-Natal, identify factors influencing its adoption, and inform strategies for effective integration into campus-based HIV prevention services. Methods: A qualitative, exploratory, cross-sectional study was conducted using semi structured interviews with 18 PHC workers from six campus health clinics at a public university in KwaZulu-Natal. Purposive sampling was employed, and data were analyzed thematically using Babchuk's 10-step process guided by Rogers' Diffusion of Innovations Theory. Results: PHC workers demonstrated limited awareness of injectable PrEP but expressed willingness to learn and adopt the intervention. Participants perceived relative advantages over oral PrEP, including improved adherence and reduced stigma. However, concerns about complexity, insufficient training, resource constraints, and workload challenges were identified as barriers. Facilitators included supportive policies, peer influence, and opportunities for pilot implementation. Conclusion: While PHC workers in campus health clinics recognize the potential benefits of injectable PrEP, significant knowledge gaps and systemic barriers must be addressed. Targeted training programs, adequate resources, and supportive institutional policies are essential for successful implementation. These findings can inform national and institutional strategies for integrating injectable PrEP into youth focused HIV prevention services.