Health Care Worker Perspectives of HIV Pre-exposure Prophylaxis Service Delivery in Central Uganda
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Frontiers in Public Health
Abstract
Scale-up of HIV pre-exposure prophylaxis (PrEP) services in Uganda is
ongoing. However, health care workers (HCWs) may not be aware of PrEP nor what
offering this service entails. We explored the impact of standardized HCW training on the
knowledge and perspectives of PrEP service delivery in Uganda.
Methods: We recruited HCWs from facilities that offered HIV-related services in Central
Uganda. Using the Uganda Ministry of Health curriculum, we trained HCWs on PrEP
services. We collected data about PrEP knowledge, preparedness, and willingness to
deliver PrEP to multiple key populations before the training, immediately after the training,
and >6 months later (exit). We additionally conducted 15 qualitative interviews after
the exit survey. Quantitative data were analyzed by Fisher exact test, while qualitative
interview data were analyzed inductively.
Results: We recruited 80 HCWs from 35 facilities in urban (N = 24, 30%), peri-urban
(N = 30, 37%), and rural (N = 26, 33%) areas. Most HCWs were nurse counselors (N
= 52, 65%) or medical/clinical officers (N = 15, 18%). Surveys indicated that awareness
of PrEP increased after the training and remained high. Knowledge of PrEP (i.e., as an
effective, short-term antiretroviral medication to use before HIV exposure for people at
high risk) generally increased with training, but significant gaps remained, and knowledge
decreased with time. Most HCWs recommended PrEP for female sex workers and HIV
serodifferent couples, as well as other key populations. We observed increases in the
number of HCW who felt their facility was prepared to cater for HIV prevention and
provide PrEP, but this view was not universal. HCWs believed in PrEP effectiveness
and embraced it as an additional HIV prevention method. Concerns included patient
adherence and behavioral risk compensation. HCWs noted challenges in PrEP delivery in
terms of inadequate clinic preparedness, infrastructure, staff capacity, and poor attitudes
toward key populations by untrained health workers. They felt further training was needed
to ensure a smooth scale-up of services without stigmatization. Standardized training improved knowledge, willingness, and
preparedness to offer PrEP services among most HCWs in Central Uganda. Ongoing
training will be needed to optimize PrEP delivery services and expand delivery to levels
needed for population-level impact.
Description
Keywords
Healthcare worker, PrEP training, HIV prevention, Serodiscordant couples, Sub-Saharan Africa
Citation
Muwonge TR, Nsubuga R, Ware NC, Wyatt MA, Pisarski E, Kamusiime B, Kasiita V, Nalukwago GK, Brown C, Nakyanzi A, Bagaya M, Bambia F, Ssebuliba T, Katabira E, Kyambadde P, Baeten JM, Heffron R, Celum C, Mujugira A and Haberer JE (2022) Health Care Worker Perspectives of HIV Pre-exposure Prophylaxis Service Delivery in Central Uganda. Front. Public Health 10:658826. doi: 10.3389/fpubh.2022.658826