From Policy To Practice: Nurses’ Experiences of Implementing Prep in Primary Health Care Clinics in Gauteng, South Africa

Oral pre-exposure prophylaxis (PrEP) implementation in South Africa primarily depends on nurses working in clinics. However, very little is known about how they interpret and apply PrEP guidelines in their daily practice. This study explored nurses' practices when implementing PrEP guidelines in clinics, employing the Donabedian framework.

A qualitative exploratory study was conducted among 19 purposively selected nurses providing PrEP services in four PHC clinics in the City of Johannesburg. Semi-structured interviews were conducted between March and May 2024, transcribed verbatim, and analysed thematically using Donabedian's framework.

Structural barriers, including limited access to updated PrEP guidelines, inadequate mentorship, staff shortages, and supply-chain disruptions, contributed to non-standardised clinical practices, inconsistent documentation, and variable patient flow. These challenges affected PrEP initiation, continuation, and implementation fidelity. Peer support, NGO involvement, and flexible patient education strategies facilitated service delivery.

The findings demonstrate that health system constraints continue to limit consistent implementation of national PrEP guidelines despite nurses' efforts to adapt their practices. Strengthening structural support is essential to improve implementation fidelity.

Improving guideline dissemination, mentorship, staffing, supply-chain management, and data systems is critical to strengthening and standardising PrEP implementation across PHC settings in South Africa.