Healthcare workers’ perspectives on HIV pre-exposure prophylaxis delivery in Sub-Saharan Africa: implications for injectable formulation rollout—a narrative review

Résumé

Background: Long-acting injectable Human Immunodeficiency Virus (HIV) pre-exposure prophylaxis (PrEP), particularly cabotegravir, presents a promising HIV prevention option in Sub-Saharan Africa (SSA), where HIV prevalence remains high. As frontline providers, healthcare workers (HCWs) are central to PrEP delivery. Given the emerging introduction of injectable PrEP in SSA, this review examines HCW perspectives on PrEP delivery broadly, including both oral and injectable formulations, with particular attention to how oral PrEP implementation experiences inform injectable PrEP readiness. Methods: A narrative review was conducted with a comprehensive literature search across PubMed, Scopus, Web of Science, EBSCOhost, and Google Scholar for English-language studies published 2020-2025. Eligible studies comprised qualitative, quantitative, and mixed-methods primary research that examined healthcare workers' knowledge, perceptions, attitudes, and readiness to deliver HIV PrEP in SSA. Relevant studies were identified, reviewed, and analyzed thematically to identify key patterns and implementation considerations. Results: A total of 742 records were identified across databases, and following review, 5 primary studies met the scope criteria, all examining oral PrEP implementation in Uganda, South Africa, Kenya, and Zimbabwe. Findings revealed varied HCW awareness and knowledge, often influenced by prior exposure to pilot initiatives. Attitudes were generally positive, emphasizing PrEP's potential to enhance adherence and reduce stigma. Reported barriers included limited training, inadequate infrastructure, increased workload, and the absence of clinical guidelines. Key facilitators included task-shifting, government commitment, targeted capacity-building, and peer-led learning. These oral PrEP implementation lessons directly inform the readiness of injectable PrEP rollout. Conclusion: Healthcare workers in SSA display positive attitudes but uneven readiness to deliver PrEP. While most evidence derives from oral PrEP implementation, lessons learned on training needs, infrastructure requirements, task-shifting strategies, and health system readiness directly inform the introduction of injectable PrEP. Addressing gaps in training, guidelines, and resources, alongside strengthening policy and system support, is essential for the effective integration and scale-up of both oral and injectable PrEP formulations.

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