Integrating PrEP and Sexual Reproductive Health Services for Adolescent Girls and Young Women in South Africa: A Scoping Review

Abstract

Adolescent girls and young women (AGYW) in South Africa bear a disproportionate burden of the global HIV epidemic. Integrating PrEP into sexual and reproductive health (SRH) services offers a promising strategy to enhance HIV prevention by aligning services with South African AGYW’s existing health-seeking behaviors. We performed a scoping review to explore considerations for integrating PrEP into SRH services for AGYW in South Africa. The review involved a comprehensive search in PubMed, Embase, and CINAHL to identify peer-reviewed studies published between 2014 and 2024. Eligible studies reported quantitative or qualitative data regarding attitudes, experiences, or program evaluation regarding PrEP integration within SRH settings in South Africa. Thirty studies met inclusion criteria, representing n = 31,610 participants. Findings revealed four key trends: (i) strong endorsement from AGYW and health care workers for integrating PrEP into SRH services; (ii) potential implementation barriers to PrEP and SRH integration including stigma, socio-economic and community constraints, provider burden, and insufficient infrastructure; (iii) factors to enable integration of PrEP and SRH services including economic and logistical benefits and the likelihood of higher PrEP uptake and adherence if it were offered alongside SRH services; (iv) considerations for integrated PrEP-SRH program design including preferences for long-acting injectable PrEP and differentiated service delivery models tailored to AGYW’s unique needs. This body of research findings provides insights for policymakers, researchers, and program designers aiming to scale up integrated HIV and SRH interventions for AGYW in South Africa with implications for other high-burden settings.