IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v361y2024ics0277953624008244.html
   My bibliography  Save this article

Applying CFIR to assess multi-level barriers to PrEP delivery in rural South Africa: Processes, gaps and opportunities for service delivery of current and future PrEP modalities

Author

Listed:
  • Baron, Deborah
  • Leslie, Hannah H.
  • Mabetha, Denny
  • Becker, Nozipho
  • Kahn, Kathleen
  • Lippman, Sheri A.

Abstract

Despite established efficacy for oral pre-exposure prophylaxis (PrEP) in reducing HIV incidence, multi-level barriers within the health system, clinics, and the processes that shape practice have hindered service delivery and subsequent population-level effects. We applied the Consolidated Framework for Implementation Research (CFIR) to assess the context of PrEP delivery for adolescent girls and young women (AGYW) in rural South Africa and identify the factors supporting and impeding PrEP implementation to develop strategies to improve PrEP delivery. Between 2021 and 2022, we conducted in-depth interviews with five young women with PrEP use experience and 11 healthcare providers as well as four key informant stakeholder interviews. Tailored interviews organized around the CFIR domains provided multiple perspectives on the inter-connected processes, gaps, and opportunities between health systems, clinics, communities, and PrEP services. Shifts in PrEP policies, funding pressures, and inconsistent communications from the National Department of Health spurred fragmented planning, engagement, execution, and monitoring of PrEP delivery processes within clinics already struggling to address multiple population health needs. Resulting challenges included: conflicting priorities within clinics and across NGO partners, unclear goals and targets, staffing and space constraints, and insufficient community engagement. Individual clinics’ implementation climate and readiness to deliver PrEP varied in terms of operational plans and delivery models. Interviewees reported complexity of initiation procedures and support for PrEP maintenance, with opportunities to improve systems communications and processes to facilitate integrated services and more user-friendly experiences. Applying CFIR identified opportunities to strengthen PrEP delivery across levels within this complex service delivery setting.

Suggested Citation

  • Baron, Deborah & Leslie, Hannah H. & Mabetha, Denny & Becker, Nozipho & Kahn, Kathleen & Lippman, Sheri A., 2024. "Applying CFIR to assess multi-level barriers to PrEP delivery in rural South Africa: Processes, gaps and opportunities for service delivery of current and future PrEP modalities," Social Science & Medicine, Elsevier, vol. 361(C).
  • Handle: RePEc:eee:socmed:v:361:y:2024:i:c:s0277953624008244
    DOI: 10.1016/j.socscimed.2024.117370
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953624008244
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2024.117370?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. WorldFish, 2020. "Annual Report 2019," Monographs, The WorldFish Center, number 40875, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Zhang, Xiaoyue & Huang, Guohe & Liu, Lirong & Li, Kailong, 2022. "Development of a stochastic multistage lifecycle programming model for electric power system planning – A case study for the Province of Saskatchewan, Canada," Renewable and Sustainable Energy Reviews, Elsevier, vol. 158(C).
    2. Rama Curiel, José Adrián & Thakur, Jagruti, 2022. "A novel approach for Direct Load Control of residential air conditioners for Demand Side Management in developing regions," Energy, Elsevier, vol. 258(C).
    3. Bellanger, Manuel & Fonner, Robert & Holland, Daniel S. & Libecap, Gary D. & Lipton, Douglas W. & Scemama, Pierre & Speir, Cameron & Thébaud, Olivier, 2021. "Cross-sectoral externalities related to natural resources and ecosystem services," Ecological Economics, Elsevier, vol. 184(C).
    4. Cardinale, Roberto & Belotti, Emanuele, 2022. "The rise of the shareholding state in Italy: A policy-oriented strategist or simply a shareholder? Evidence from the energy and banking sectors’ privatizations," Structural Change and Economic Dynamics, Elsevier, vol. 62(C), pages 52-60.
    5. Sinha, Sarvajeet Kumar & Srikanth, R. & Mahalingam, Sudha, 2022. "Regulatory framework for India's energy security and sustainability," Energy Policy, Elsevier, vol. 162(C).
    6. Li, Tao & Rong, Lili, 2022. "Spatiotemporally complementary effect of high-speed rail network on robustness of aviation network," Transportation Research Part A: Policy and Practice, Elsevier, vol. 155(C), pages 95-114.
    7. Xiao, Jucheng & He, Guangyu & Fan, Shuai & Li, Zuyi, 2022. "Substitute energy price market mechanism for renewable energy power system with generalized energy storage," Applied Energy, Elsevier, vol. 328(C).
    8. Hernandez, Adrian & Ng, Max & Durango-Cohen, Pablo L. & Mahmassani, Hani S., 2024. "Optimizing service networks to support freight rail decarbonization: Flow selection, facility location, and energy sourcing," European Journal of Operational Research, Elsevier, vol. 317(3), pages 906-920.
    9. Meghann Puloc’h, 2022. "Uganda: revising the growth model while preserving debt sustainability," Working Paper 1a139887-666a-4a53-8b6a-5, Agence française de développement.
    10. Chatterjee, Swagato & Kittur, Prathamesh & Vishwakarma, Pankaj & Dey, Anirban, 2023. "What makes customers of airport lounges satisfied and more? Impact of culture and travel class," Journal of Air Transport Management, Elsevier, vol. 109(C).
    11. Gordon, Jeffrey M. & Fasquelle, Thomas & Nadal, Elie & Vossier, Alexis, 2021. "Providing large-scale electricity demand with photovoltaics and molten-salt storage," Renewable and Sustainable Energy Reviews, Elsevier, vol. 135(C).
    12. Graham, Cameron & Himick, Darlene & Nappert, Pier-Luc, 2024. "The dissipation of corporate accountability: Deaths of the elderly in for-profit care homes during the coronavirus pandemic," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 99(C).
    13. Bartulović Marijana, 2021. "Forensic accounting: state and development perspectives in the Republic of Croatia," Journal of Forensic Accounting Profession, Sciendo, vol. 1(2), pages 48-63, December.
    14. Bjerke, Lise, 2022. "Antibiotic geographies and access to medicines: Tracing the role of India's pharmaceutical industry in global trade," Social Science & Medicine, Elsevier, vol. 312(C).
    15. Kanupriya Jain & Piyali Ghosh & Shankha Shuvra Misra, 2023. "The Future of Fixed-term Employment in India," Vikalpa: The Journal for Decision Makers, , vol. 48(2), pages 87-99, June.

    More about this item

    Keywords

    PrEP; CFIR; AGYW; HIV; South Africa;
    All these keywords.

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:361:y:2024:i:c:s0277953624008244. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.