Barriers to implementation of HIV pre-exposure prophylaxis (PrEP) guidelines in Gauteng, South Africa: A qualitative study of nurses’ perspectives

Abstract

Introduction

South Africa has one of the largest HIV burdens globally making Pre-Exposure-Prophylaxis (PrEP) a critical prevention intervention. Although national recommendations for PrEP were issued in 2016, barriers to implementation persist, particularly within the public healthcare setting.

Purpose

This study aimed to investigate the systemic barriers experienced by nurses in public clinics when implementing PrEP guidelines within Johannesburg, Gauteng Province.

Methods

A qualitative exploratory design using purposive sampling was employed. The researcher recruited 34 registered nurses who are actively involved in providing PrEP services from four municipal clinics in Johannesburg Sub-districts A and E. However, 19 nurses participated in the study. Data were collected through in-depth, semi-structured interviews and analysed using thematic analysis to identify key patterns and insights.

Results

The analysis revealed four primary barriers to the implementation of PrEP guidelines. Firstly, workforce preparation emerged as a major challenge, particularly the lack of prerequisite PrEP-specific training and the associated fears among nurses who perceived the services as “unfamiliar.” Secondly, resource constraints were evident, characterised by frequent stockouts of PrEP drugs and shortages of essential supplies necessary for effective service delivery. Thirdly, infrastructure limitations, especially the absence of private consultation spaces, compromised client confidentiality and hindered the quality of care. Lastly, challenges in information management were observed, including poor filing systems and incomplete electronic records, which made it difficult to track clients and ensure appropriate follow-up. Collectively, these barriers significantly impeded the effective rollout of PrEP services within the study setting.

Conclusion

Policy-level interventions targeting nurse training, supply chain management, clinic infrastructure, and health information systems—alongside ensuring an enabling policy environment—are essential for effective PrEP rollout in South Africa. Strengthening these domains will enhance sustainable PrEP delivery, safeguard patient privacy, and contribute to optimal HIV prevention. Resource allocation should align with South Africa’s National Strategic Plan (2023–2028) to facilitate the integration of PrEP services into routine primary healthcare.