JMIR Publications

ABSTRACT

Background:

Oral pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition when taken consistently. However, despite widespread availability of PrEP in South Africa, uptake and utilization remain suboptimal. Innovative delivery models are needed to address logistical, economic, and social barriers to PrEP access. Evidence on community pharmacy and online PrEP delivery in South Africa remains limited and, to our knowledge, these approaches have not been evaluated together within the same implementation program. The Pharmacy-Delivered Pre-Exposure Prophylaxis in South Africa (PPREPP-SA) initiative implemented in-pharmacy and telehealth-supported online oral PrEP delivery models to address this gap.

Objective:

Using the RE-AIM framework, this study aimed to evaluate the feasibility and acceptability of initiating and maintaining oral PrEP through community pharmacies and a telehealth-supported online platform in Gauteng and the Western Cape, South Africa. We also assessed provider and individual level facilitators and barriers to PrEP uptake and continuation across both delivery models.

Methods:

This longitudinal implementation science study used a divergent parallel mixed methods design. The study targeted 1700 adults initiating PrEP through 10 community pharmacies in Gauteng and the Western Cape and 250 adults initiating PrEP through a telehealth-supported online model. Quantitative data included sociodemographic characteristics, sexual health risk, PrEP initiation, and persistence at scheduled follow-up visits at months 1, 4, 7, 10, and 13. Qualitative interviews were conducted at baseline, midpoint (months 6-7), and endline (month 13) with PrEP clients, pharmacy providers, and key stakeholders. RE-AIM was used to organize implementation outcomes, and qualitative and quantitative findings were integrated during interpretation.

Results:

Participant enrolment began on June 23, 2023. The protocol projected recruitment completion by March 30, 2025, and final participant follow-up by May 31, 2026. At the time this manuscript was prepared, data collection, cleaning, and qualitative analyses has been completed which quantitative analyses is ongoing. A total of 1,697 participants-initiated PrEP through the pharmacy-based delivery model, and 230 participants-initiated PrEP through the online delivery model. Substantive findings are being reported separately with the expected date of the first results manuscript scheduled for journal submission in December 2026.

Conclusions:

This study will provide implementation evidence on whether community pharmacies and a telehealth supported online model can expand access to oral PrEP in South Africa. Understanding barriers and facilitators across both models can inform delivery strategies that are practical, sustainable, and responsive to HIV prevention priorities. Clinical Trial: ClinicalTrials.gov: NCT07006246