Delivery models of HIV pre-exposure prophylaxis and their influence on uptake in South Africa: An integrative review

Background: Maximising the use of HIV pre-exposure prophylaxis (PrEP) is crucial to eliminate new HIV transmissions, especially in high-prevalence areas such as South Africa. Strengthening access and acceptability of PrEP is essential for effective HIV prevention and to ensure sufficient uptake among those at risk. Objectives: This review aims to explore the existing PrEP delivery models in the South African public health settings and their influence on its uptake. Method: An integrative review approach was followed and electronic databases, namely PubMed, Medline, EBSCOhost, and Google Scholar, were searched. We selected qualitative and quantitative studies that focused on South Africa, written in English, and were published in peer-reviewed journals between 2016 and 2024. Results: Two distinct models were identified, namely the health facility-based model and the community-based model which is inclusive of the use of pharmacies. Both models have constraints and facilitators that impact on access and acceptability, thus influencing uptake. Conclusion: Decentralisation as a means to ensure access, and awareness to facilitate acceptability, are critical drivers of the PrEP service’s success. Therefore, it is critical to develop intervention strategies that focus on access and acceptability among the target population, driven by the need to overcome barriers and ensure sustainability.