South Africa continues to grapple with one of the world's highest HIV burdens, with approximately 7.8 million people living with HIV as of 2025, according to the latest Thembisa model estimates from the Human Sciences Research Council (HSRC). Despite advances in antiretroviral therapy (ART), new infections remain a challenge, particularly among adolescent girls and young women (AGYW) and other key populations. Pre-exposure prophylaxis (PrEP), a highly effective biomedical intervention, has been pivotal since its national rollout in 2016. However, uptake has fluctuated, peaking at over 1 million initiations before declining due to funding cuts and supply issues, now stabilizing around 200,000-500,000 active users. Integrating PrEP into sexual and reproductive health (SRH) services offers a promising strategy to boost access, but healthcare providers' views are crucial for success.
A groundbreaking qualitative study led by researchers from the University of the Witwatersrand's Reproductive Health and HIV Institute (Wits RHI) sheds light on these perceptions. Published on February 27, 2026, in Frontiers in Reproductive Health, the research titled "Bridging HIV Prevention and Sexual Reproductive Health Services in the Context of Multi-Method PrEP: A Qualitative Study Exploring Provider Perceptions in South Africa" captures insights from 30 frontline healthcare providers (HCPs) in Gauteng and KwaZulu-Natal provinces.
Understanding PrEP and Multi-Method Options in South Africa's HIV Landscape
PrEP involves taking antiretroviral medications before potential exposure to HIV to prevent infection. Daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC, branded Truvada) was the initial option, but multi-month and long-acting formulations are transforming delivery. These include multi-month dispensing (3-6 months supply), cabotegravir long-acting injectable (CAB-LA, every two months), and the dapivirine vaginal ring (monthly). South Africa began rolling out CAB-LA in 2024 and twice-yearly lenacapavir in late 2025, following PURPOSE 1 trial results showing near-100% efficacy.
SRH services encompass contraception, STI screening, cervical cancer screening, and pregnancy care—areas where HIV risk intersects. Clinics already offer integrated HIV/SRH care, but adding PrEP requires adapting workflows. The Wits study explores how providers view this in a 'multi-method PrEP' era, where choice enhances adherence but complicates implementation.
The Wits RHI Study: Methods and Participant Insights
Led by Faith Mary Musvipwa, Siphokazi Dada, and colleagues from Wits RHI—with contributions from Anova Health Institute—the study used in-depth interviews (IDIs) with 30 HCPs, including nurses, counselors, and doctors delivering both PrEP and SRH services. Sites were public clinics in high-prevalence areas of Gauteng and KwaZulu-Natal, where HIV incidence exceeds 2% annually among AGYW.
Interviews, conducted in 2025, explored experiences with current integration, views on multi-method PrEP, barriers, and facilitators. Thematic analysis revealed nuanced perceptions: most providers (80%) supported integration for holistic care, but highlighted systemic hurdles.
- Diverse roles: Providers ranged from PrEP champions to SRH specialists, offering balanced views.
- Context: Clinics serve ~500-2000 clients monthly, with PrEP uptake at 5-15% of eligibles.
Positive Perceptions: Why Providers Champion Integration
Providers praised integration for client-centered care. One nurse noted, "Women come for family planning; offering PrEP normalizes HIV prevention like any contraceptive." Key benefits included:
- Increased PrEP uptake via 'one-stop' services, reducing stigma.
- Better adherence through SRH follow-ups (e.g., ring checks align with Pap smears).
- Empowerment of AGYW, who comprise 25% of new infections.
Multi-method options were welcomed: CAB-LA seen as discreet for partners unaware, ring user-friendly for youth. 70% believed choice would boost persistence, echoing global trials like HPTN 084.
Challenges Highlighted by Providers: Training, Workload, and Stigma
Despite enthusiasm, barriers loomed large. Lack of training on new modalities affected 60% of respondents:
| Challenge | Provider Quote/Example |
|---|---|
| Training Gaps | "We know oral PrEP, but injectables? No guidelines yet." |
| Workload | Extra counseling adds 15-20 mins per client in overburdened clinics. |
| Stigma/Supply | HIV stigma persists; stockouts for oral PrEP common. |
| Client Factors | Fear of side effects, partner disclosure issues. |
Similar issues in prior Wits studies: a 2023 Frontiers paper found ambivalence due to time constraints. Recent funding cuts exacerbated supply woes, dropping initiations 28%.
Comparing with Earlier Research: Evolution of Provider Views
The 2026 Wits study builds on 2023 findings from the same group, where providers were ambivalent about youth-friendly integration. Progress: Greater optimism post-CAB-LA approval. UCT's IDM PURPOSE trials reinforced long-acting efficacy, influencing perceptions.
A 2024 scoping review mapped AGYW integration considerations, echoing provider calls for task-sharing (nurses dispensing injectables).Read the review
HSRC data shows SRH clinics could reach 1.5M more via integration, vital as PrEP covers only 10% of need.
PrEP Uptake Trends and SRH Synergies in South Africa
PrEP initiations surged to 1M+ in 2022 but fell amid PEPFAR cuts. 2025 saw recovery with lenacapavir pilots at Wits sites. SRH platforms: 80% of AGYW access contraception yearly, per SAMRC.
- Gauteng: 15% clinic integration rate.
- KZN: High incidence drives pilots.
Policy and Training Recommendations from Providers
Providers urged:
- National guidelines for multi-method PrEP in SRH.
- Training via universities like Wits, targeting 50,000 HCPs.
- Task-shifting to community health workers.
- Demand creation: Community education on choices.
SANAC's 2025 strategy aligns, funding Wits-led pilots. Link to higher-ed-jobs for public health roles advancing this.
South African Universities Driving PrEP Research
Wits RHI leads, with Project PrEP (Unitaid-funded) testing dapivirine ring. UCT's IDM ran PURPOSE trials; UKZN trials HIV vaccines. Stellenbosch models integration costs. These institutions train future providers, offering professor ratings for aspiring researchers. Explore SA university jobs.
Future Outlook: Scaling Multi-Method PrEP via SRH
With lenacapavir's 100% efficacy, integration could avert 500,000 infections by 2030 (AVERT modeling). Challenges persist: funding, equity. Providers optimistic if supported. Students: Pursue public health at Wits for impact.
Actionable Insights for Providers, Policymakers, and Students
- Providers: Use SRH visits for PrEP screening; advocate training.
- Policymakers: Prioritize supply chains, guidelines.
- Students: Research opportunities at Wits via career advice; check university jobs.
Visit Rate My Professor for courses; apply at higher-ed-jobs.
This Wits-led study underscores integration's potential amid multi-method PrEP evolution. By addressing provider concerns, South Africa can enhance HIV prevention. For roles advancing this, explore higher ed jobs, rate professors, and career advice.
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