# PrEP and choice counselling – Insights into implementation

## TL;DR

This study explores how healthcare providers in South Africa implement choice counseling for HIV prevention methods like PrEP and the dapivirine vaginal ring.

## Contribution

The study introduces a participatory process to evaluate and improve choice counseling for new HIV prevention methods.

## Key findings

- Healthcare providers need balanced communication and should avoid personal bias when discussing PrEP options.
- One-time training and job aids are insufficient; ongoing engagement is needed to address gaps in choice counseling.
- Active engagement with providers helps identify implementation challenges and informs future training.

## Abstract

Adolescent girls and young women are disproportionately affected by human immunodeficiency virus (HIV). The introduction of oral pre-exposure prophylaxis (PrEP) was a game-changer in HIV prevention. In 2023, the dapivirine vaginal ring (DVR) was introduced in select implementation research sites in South Africa, introducing a new dimension into HIV prevention service delivery – people were now able to choose their PrEP method and switch between methods. As new PrEP products are introduced, choice has taken centre stage in HIV prevention service delivery. In these field notes, we describe an iterative, participative process to gain insight into choice counselling training and implementation. Healthcare providers were trained on both DVR and PrEP choice counselling. Guided by the Transfer of Learning Matrix, we embarked on a process with the aim of assessing how choice counselling was being implemented at site level to identify gaps and inform future training and mentoring in relation to effective choice counselling. Healthcare providers involved in delivering DVR in the three implementing clusters were purposefully invited to participate in interviews. A total of 42 interviews were conducted with both clinical and non-clinical providers between December 2023 and January 2024. All interviews were audio-recorded, transcribed verbatim and analysed thematically.

Findings include the importance of healthcare providers communicating in a balanced manner and not letting personal bias interfere, and that one-off trainings and job aids for choice counselling are not enough and need to be supplemented by active engagement with healthcare providers on the ground to identify gaps and inform ongoing in-service training and mentoring.