How PrEP delivery was integrated into public ART clinics in central Uganda: a qualitative analysis of implementation processes
Open accessAbstract
Tailored delivery strategies are important for optimizing the benefit and overall reach of PrEP in sub-Saharan Africa. An integrated approach of delivering time-limited PrEP in combination with ART to serodifferent couples encourages PrEP use in the HIV-negative partner as a bridge to sustained ART use. Although PrEP has been delivered in ART clinics for many years, the processes involved in integrating PrEP into ART services are not well understood. The Partners PrEP Program was a stepped-wedge cluster randomized trial of integrated PrEP and ART delivery for HIV serodifferent couples in 12 public health facilities in central Uganda (Clinicaltrials.gov NCT03586128). Using qualitative data, we identified and characterized key implementation processes that explain how PrEP delivery was integrated into existing ART services in the Partners PrEP Program. In-depth interviews were conducted with a purposefully-selected sub-sample of 83 members of 42 participating serodifferent couples, and with 36 health care providers implementing integrated delivery. High quality training, technical supervision, and teamwork were identified as key processes supporting providers to implement PrEP delivery. Interest in the PrEP program was promoted through the numerous ways health care providers made integrated ART and PrEP meaningful for serodifferent couples, including tailored counseling messages, efforts to build confidence in integrated delivery, and strategies to create demand for PrEP. Couples in the qualitative sample responded positively to providers’ efforts to promote the integrated strategy. HIV-negative partners initiated PrEP to preserve their relationships, which inspired their partners living with HIV to recommit to ART adherence. Lack of disclosure among couples and poor retention on PrEP were identified as barriers to implementation of the PrEP program. A greater emphasis on understanding the meaning of PrEP for users and its contribution to implementation promises to strengthen future research on PrEP scale up in sub-Saharan Africa.
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Wyatt et al. 2024 was designed as a stepped-wedge cluster randomized trial.
“The study was designed as a stepped-wedge cluster randomized trial.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [84]
The Methods (‘Study background and design’) describe the Partners PrEP Program as a stepped-wedge cluster randomized trial. Wyatt et al. 2024, however, is a qualitative study nested within that trial, not the trial itself. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe stepped-wedge design in Wyatt et al. 2024 was chosen to allow for the staggered implementation of the intervention across the different facilities.
“The stepped-wedge design was chosen to allow for the staggered implementation of the intervention across the different facilities”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [84]
The Methods section (‘Study background and design’; page not provided) identifies the Partners PrEP Program as a stepped-wedge cluster randomized trial in 12 public health facilities. Our copy does not say that this design was chosen to allow staggered implementation across facilities; that stated reason for the choice is unsupported. (LLM, conf=0.82)
Experimental — accuracy not yet measured
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Cited by
Sorted by citations
Musa, Z. A., Akinsolu, F. T., Salako, A. O., Abodunrin, O. R., Ola, O. M., & Ezechi, O. C. (2026) · Frontiers in Epidemiology · doi:10.3389/fepid.2026.1529289
- Authors
- Wyatt, M. A., Pisarski, E. E., Nalumansi, A., Kasiita, V., Kamusiime, B., Nalukwago, G. K., Thomas, D., Muwonge, T. R., Mujugira, A., Heffron, R., Ware, N. C., & for the Partners PrEP Program Study Team
- Affiliations
- Harvard University (US)
- Infectious Diseases Institute (UG)
- University of Washington (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Wyatt, Monique A.
- ORCID
- Venue
- PLOS Global Public Health
- Publisher
- Public Library of Science (PLoS)
- Published
- 2024-03-07
- Volume
- 4
- Issue
- 3
- Pages
- e0002916
- ISSN
- 2767-3375 (ISSN-L)
- PMC
- PMC10919847
- OpenAlex
- W4392544827
- Cited by
- 1
- References
- 31
- Citations by year
- 2026: 1
- FWCI
- 0.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLOS Global Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Mental Health (R01MH110296)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- HIV PrEP, pre-exposure prophylaxis, implementation process, health professions education, technical supervision, PrEP retention, HIV status disclosure, antiretroviral therapy adherence, HIV prevention scale-up, Uganda
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