Bridging HIV prevention and sexual reproductive health services in the context of multi-method PrEP: a qualitative study exploring provider perceptions in South Africa

Introduction: The introduction of new pre-exposure prophylaxis (PrEP) methods presents an opportunity to expand choice and better integrate HIV prevention and broader sexual and reproductive health (SRH) services. Integrating HIV prevention services, including PrEP, and SRH services presents an opportunity to improve healthcare access and outcomes. However, implementation within real-world healthcare settings requires an understanding of both enablers and barriers from the perspective of healthcare providers (HCPs). Methods: A qualitative descriptive study was conducted using in-depth interviews (IDIs) to describe the integration of PrEP and SRH services, drawing on the perspectives of HCPs. Thirty-four HCPs were purposively sampled and interviewed between October and November 2024 across four South African locations: eThekwini, Gqeberha, Mthatha, and Tshwane. Audio recordings were transcribed, translated, and analysed using inductive thematic analysis with NVIVO 14 software. Results: Key benefits of service integration expressed by HCPs included increased continuity of care with the same HCP, convenience, and a higher uptake of SRH services, such as contraception and sexually transmitted infection (STI) screening and management. Facilitators included integrated education and awareness, flexibility in alignment of appointment schedules, and positive staff attitude. Challenges and barriers included misalignment between injectable PrEP and injectable contraceptive visit schedules and infrastructural limitations within some public health facilities. Conclusions: Successful integration requires adaptable systems, responsive scheduling, functional infrastructure, and positive staff attitude. To improve uptake and continuity of SRH services, health systems should be flexible and provide holistic services that align with client needs.