Provider perspectives on PrEP for adolescent girls and young women in Tanzania: The role of provider biases and quality of care

PLoS One. 2018 Apr 27;13(4):e0196280. doi: 10.1371/journal.pone.0196280. eCollection 2018.


Background: Oral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, health care providers' (HCPs) perspectives and interactions with potential clients can substantially influence effective provision of quality health services. We examine if HCPs' knowledge, attitude, and skills, as well as their perceptions of facility readiness to provide PrEP are associated with their willingness to provide PrEP to AGYW at high risk of HIV in Tanzania.

Methods: A self-administered questionnaire was given to 316 HCPs from 74 clinics in two districts and 24 HCPs participated in follow-up in-depth interviews (IDIs). We conducted bivariate and multivariable Poisson regression to assess factors associated with willingness to provide PrEP to AGYW. Thematic content analysis was used to analyze the IDIs, which expanded upon the quantitative results.

Results: Few HCPs (3.5%) had prior PrEP knowledge, but once informed, 61.1% were willing to prescribe PrEP to AGYW. Higher negative attitudes toward adolescent sexuality and greater concerns about behavioral disinhibition due to PrEP use were associated with lower willingness to prescribe PrEP. Qualitatively, HCPs acknowledged that biases, rooted in cultural norms, often result in stigmatizing and discriminatory care toward AGYW, a potential barrier for PrEP provision. However, better training to provide HIV services was associated with greater willingness to prescribe PrEP. Conversely, HCPs feared the potential negative impact of PrEP on the provision of existing HIV services (e.g., overburdened staff), and suggested the integration of PrEP into non-HIV services and the use of paramedical professionals to facilitate PrEP provision.

Conclusions: Preparing for PrEP introduction requires more than solely training HCPs on the clinical aspects of providing PrEP. It requires a two-pronged strategy: addressing HCPs' biases regarding sexual health services to AGYW; and preparing the health system infrastructure for the introduction of PrEP.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Attitude of Health Personnel*
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / prevention & control*
  • Health Knowledge, Attitudes, Practice
  • Health Personnel / education*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Outcome Assessment, Health Care
  • Patient-Centered Care
  • Poisson Distribution
  • Practice Patterns, Physicians' / statistics & numerical data
  • Pre-Exposure Prophylaxis*
  • Prejudice
  • Quality of Health Care
  • Risk
  • Rural Population
  • Sexual Behavior
  • Surveys and Questionnaires
  • Tanzania
  • Urban Population
  • Young Adult


  • Anti-HIV Agents

Grants and funding

Funded by Bill & Melinda Gates Foundation-OPP1150068- Bill & Melinda Gates Foundation-OPP1136778- The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. CSK Research Solutions (CSK) is a private firm that supports design and implementation of research studies and program monitoring and evaluation activities in Tanzania. CSK did not fund the study but served as the Tanzanian research partner in the study. CSK received a sub-contract from the Population Council to collect data, participate in data analysis and participate in the preparation of the manuscript.