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

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.