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Implementing the new WHO guidelines on HIV post-exposure prophylaxis: perspectives from five African countries.

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Expanding access to post-exposure prophylaxis (PEP) in communities is crucial for HIV prevention. Strategies and stakeholder insights from five African nations highlight the need for awareness, policy alignment, and resources to overcome implementation barriers.

Keywords:
HIV PEPHIV preventionPEP to PrEPWorld Health Organizationglobal guidancepost‐exposure prophylaxis

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Area of Science:

  • Public Health
  • HIV Prevention
  • Global Health Policy

Background:

  • Post-exposure prophylaxis (PEP) is vital for HIV prevention but faces suboptimal global uptake.
  • The World Health Organization (WHO) updated PEP guidance in July 2024 to improve access, including community-based delivery and task-sharing with community health workers.
  • Implementing new public health guidelines presents complexities, necessitating an understanding of practical realities for successful adoption.

Purpose of the Study:

  • To explore stakeholder perspectives on barriers and strategies for implementing new WHO PEP recommendations in five African countries.
  • To identify key themes influencing PEP uptake and utilization within community settings.
  • To inform the feasibility of expanded PEP access through community-based approaches and task-sharing.

Main Methods:

  • Gathering stakeholder perspectives from Kenya, Nigeria, South Africa, Uganda, and Zimbabwe through a workshop.
  • Analyzing shared experiences to identify themes related to PEP implementation.
  • Focusing on barriers and successful mitigation strategies for expanded PEP access.

Main Results:

  • Key themes include awareness, acceptability, administration, monitoring, policy alignment, logistics, service integration, stakeholder involvement, capacity building, and linking PEP with Pre-Exposure Prophylaxis (PrEP).
  • Socio-cultural norms and the need for increased resources for implementation, capacity strengthening, and community monitoring are significant cross-cutting issues.
  • Successful efforts in some countries leverage existing community resources and capacities to overcome challenges.

Conclusions:

  • Significant challenges exist in expanding PEP access in community settings and via task-sharing.
  • Innovative approaches utilizing community resources and multi-stakeholder engagement are essential to address awareness gaps, logistical/regulatory hurdles, and political will.
  • Continued collaboration and innovation are critical for countries updating guidelines to align with WHO recommendations and maximize PEP's potential in HIV prevention.