A Qualitative Consolidated Framework for Implementation Research Evaluation of Innovative PrEP Delivery During COVID-19 Among Adolescent Girls and Young Women in North West Province, South Africa

Background: Innovative interventions, such as social media platforms and telemedicine, were implemented during the COVID-19 lockdown period for HIV prevention and treatment services. However, limited studies have reported on the facilitators and barriers of these innovations for HIV pre-exposure prophylaxis (PrEP) service continuity. Therefore, this study aimed to identify the barriers and facilitators of the implemented PrEP innovative interventions during COVID-19 among adolescent girls and young women (AGYW). Methods: A qualitative exploratory design was used to conduct semi-structured interviews with twelve stakeholders in the Dr Kenneth Kaunda District, North West Province of South Africa. Participants included various TB HIV Care programme stakeholders, comprising professional nurses, case managers, peer educators, and counsellors. The Consolidated Framework for Implementation Research (CFIR) 2.0 domains and constructs guided the interview questions and the analysis process. Additionally, all interviews were audio-taped, transcribed verbatim, and analyzed through thematic analysis. The facilitators and barriers of the PrEP innovative interventions were categorized according to the five CFIR domains. Results: The findings showed that despite the COVID-19 disruptions in healthcare services, the implemented innovative PrEP interventions enhanced the HIV prevention services. Facilitators included sufficient mobile data, teamwork, clear communication from managers, resilience, and existing media pages that supported social media-based PrEP service continuity. The implementation barriers included service users’ lack of cell phone devices, incorrect personal information, fear of contracting COVID-19, and limited individual movements. Conclusion: Social media and digital technologies played a crucial role in the continuation of HIV PrEP services among AGYW. These evaluations also illustrated the potential of social media platforms to be leveraged for HIV service delivery during periods of disruption, such as the COVID-19 lockdown period, for HIV service delivery. Furthermore, lessons learned from this study are significant and offer practical considerations for sustaining PrEP during service disruptions.