Strategies to enhance HIV Pre-Exposure Prophylaxis uptake and retention amongst young females at Gauteng province

Thesis (PhD (Nursing Science))--University of Pretoria, 2022.Introduction: Despite the HIV Pre-Exposure Prophylaxis (PrEP) being approved by Food and Drug Administration since 2012 as the recommended HIV prevention intervention, the achievement of satisfactory uptake and retention remains unmet across the globe. This concern contributes to increased number of new HIV infections. To combat this HIV pandemic, the recommended intervention is to accelerate PrEP performance, both uptake and retention. Therefore, it was crucial to conduct a study aiming at developing strategies to enhance PrEP uptake and retention amongst young females at Gauteng Province as little was known addressing this gap. Research design: This study followed an explanatory sequential mixed method design. Wherein phases one used quantitative retrospective patient records’ audit following consecutive sampling to gather data from 01/01/2017-31/12/2020 to assess PrEP uptake and retention amongst young females. The data was collected using developed data collection tool and data was analysed using Statistical Package for the Social Sciences Version 27. While, phase two used qualitative explorative descriptive methods to explore and describe registered nurses and young females’ perceptions regarding PrEP uptake and retention. Wherein purposive sampling was used to select both participants. Focus group discussions were held for registered nurses while semi-structured interviews for young females were conducted. Both data were analysed separately using six steps of thematic analysis and merged to find similarities and differences to report comprehensive findings. Phase three was an interpretation of phase one and two findings and meta-inference. Moreover, phase four was the modified e-Delphi technique to reach consensus amongst PrEP experts on the most important and feasible strategies to enhance PrEP uptake and retention. Results: Phase one analysis reported statistical data of PrEP uptake and retention assessment suggesting that it was low as measured against targets. The explored and described perceptions of registered nurses and young females on PrEP were transcribed and analysed in phase two. Wherein three themes emerged with fourteen sub-themes and fifty categories. In phase three, quantitative results and qualitative findings were integrated to draw comprehensive meaning from both data set collected and analysed to set the base for phase four. Consensus from the two rounds of the modified e-Delphi technique conducted, concluded with twenty-five strategies developed to enhance HIV PrEP uptake and retention amongst young females in phase four. Conclusion: This study reports the strategies developed to enhance HIV PrEP uptake and retention amongst young females following both the explanatory sequential mixed method design and modified e-Delphi technique in four (4) phases. The first three (3) phases followed an explanatory sequential mixed method design while the fourth (4) phase followed the modified e-Delphi technique. The first phase reported assessment of PrEP uptake and retention, relationship between dependent and independent variables. While phase two reported the explored and described perceptions of registered nurses and young females on HIV PrEP uptake and retention. The assessment and explored perceptions were merged in phase three to set base for phase four wherein modified e-Delphi technique was used to reach consensus on the most feasible and important strategies to enhance HIV PrEP uptake and retention. The analysis concluded with twenty-five (25) strategies to enhance HIV PrEP uptake and retention amongst young females at Gauteng province. The findings of this study concluded that, despite PrEP being effective for HIV prevention, there are challenges that should be curbed with developed strategies to enhance PrEP uptake and retention amongst young females. Recommendations: This study recommends that research ought to be conducted to implement the strategies developed in practice to improve HIV PrEP usage amongst young females. As such, data may influence policy makers to develop implementation plans considering the best strategies to enhance HIV PrEP uptake and retention. Moreover, other healthcare categories and patients should be well trained with the latest information on strategies to improve PrEP. Key concepts: Strategies, Enhance, HIV Pre-Exposure Prophylaxis, Uptake, Retention, Young FemalesNational Research Foundation of South Africa (orcid.org/0000-0002-5603-2920) University of Pretoria Postgraduate Bursary (20814594)Nursing SciencePhDUnrestricte