Investigating Barriers to Pre-Exposure Prophylaxis Uptake to Prevent HIV Among General Population of Sub-Saharan Africa Countries- A Systematic Review

Download Article

DOI: 10.21522/TIJAR.2014.12.04.Art022

Authors : Zanele Patience Simelane

Abstract:

Sub-Saharan Africa is one of the regions were the prevalence of HIV is high. Many strategies have been introduced to fight HIV in these countries including Pre-exposure prophylaxis (PrEP). The uptake of PrEP has been low in these countries thus this review aims to investigate the barriers to PrEP uptake among the general population of Sub-Saharan Africa countries. A systematic review was conducted and the research studies that were used were selected from google scholar and PubMed databases. Twelve (12) studies were analyzed to determine the barriers to Pre-exposure prophylaxis uptake among the general population of Sub-Saharan Africa countries. Majority of the studies revealed that barriers to Pre-exposure prophylaxis were stigma, fear of side effects, lack of knowledge, pill burden, lack of transport to the health facility, distance from the facility, attitude of health care workers and stock out of medications. There is need to increase PrEP awareness in these countries so to reduce the level of stigma attached to PrEP and improve access to health facilities.

References:

[1].   United Nations Programme on HIV/AIDS (AIDS)., 2024, Global HIV and AIDS Statistics. http://unaids.org/en/resources/fact-shets.

[2].   Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)., 2025, Adolescents and HIV. http://pedaids.org/adolescents-and-hiv.

[3].   HIV and AIDS in East and Southern Africa Regional Awareness Overview., Avert. 2019, http://www.avert.org/professionals/hiv-around-world-sub-saharan-africa/overvew

[4].   World Health Organisation. 2025, Pre-Exposure Prophylaxis PrEP, Global HIV Programme. WHO. Geneva. http://www.who.int/teams/global-hiv.

[5].   Center for Disease Control (CDC)., 2024, Preventing HIV with PrEP. http://www.cdc.gov/hiv/prevention/prep/html.

[6].   Global HIV/AIDS Organizations., 2025, Pre- Exposure Prophylaxis, HIV org. http://www.hiv.gov-basics/hiv-prevention/using-hiv-medication

[7].   Center for Disease Control (CDC)., 2024, Morbidity and Mortality Weekly Reports Progress Towards UNAIDS Global HIV Pre-exposure Prophylaxis Targets: CDC-supported Oral Pre-Exposure Prophylaxis-37 Countries 2017-2023. http://www.cdc.gov/mmusr/volumes/73/wr/mm7347a3.htm

[8].   Admassu, A., Nostlinger, C., & Hensen, B., 2024, Barrier to PrEP use and adherence among adolescent girls and young women in Eastern, Southern and Western Africa. BMC Women’s Health. NO: 665.ISSN:14726874.

[9].   Muhunuza, R., Ssemata, A. S., Kakande, A., Ahmend, N., Atujura, M., & Mangxilana, N., 2021, Exploring Perceived Barriers and facilitators of PrEP Uptake among in Uganda, Zimbabwe and South Africa. Volume 50.1729-1742.

[10].  Ashipala, D. O., 2024, Exploring Factors hindering the Uptake of HIV Pre-Exposure Prophylaxis by potential users in Namibia. 2024. S Afr J hv. Med. 2024:25(1) 91561. http://doi.org/10.4102/sajhiumed.v25il.1561

[11].  Nicholus, S. C., Matewere, M., Bula, A., Tsidya, M., Hosseinnipour, M. C., Matoga, M., & Mipando, N., 2025, http://doi.org/10.1371/journal.pgph.0004006

[12].  Gombe, M. M., Cakourous, B. E., Ncube, G., Zwangobani, N., Mareke, P., Mkwambs, A., Prescott, M. A., Bhalasara, T., Murwira, M., Mangwiro, A., & Prust, M. L., 2020, Key Barriers and Enablers Associated with PrEP Uptake and Continuation of Oral PrEP in Public Sector Zimbabwe: Qualitative Perspective of General Population Clients at High Risk. PLOS One. 2020. Jan13; 15(11): e0227632. http://doi10:1371. Journal.prone.0227632. PMID: 31931514.

[13].  Gibson, J., Ezema, A. U., Orero, W., Were, I., Osasogie, O., Mbulto, P. O., & Hirschhorn, L. R, 2021. Facilitators and Barriers to HIV Pre-Exposure Prophylaxis Uptake through a Community-based Intervention Stratergy among Adolescent girls and young women in Semi-Sub-country. Volume:21. Article number: 1284(20210. http://10.1186/512889-021-11335-1

[14].  Zotova, N., Shongo, A., Lelo, P., Mbonze, N., Koba, D., Ntangu, P., Shi, Q., Adedimeji, A., Anastos, K., Yatobeina, M., Patel, V., & Ross, J., 2024, Low Retention on PrEP and Barriers to PrEP use among Key Population in Kinshasa, DRC: A mixed method study. http://doi.org/10.1101/2024.12.18.24318849.

[15].  Stoebenau, K., Muchaga, G., Ahmad, S. S., Bwalya, C., Muvale, M., Toussant, S., Maambo, C., Peter, C. J., Baumhart, C., Mwango, I. k., Lavoie, M. C., & Claassen, C. W., 2024, Barriers and Facilitators to Uptake and persistence on PrEP among Key Population in Southern Province in Zambia: A Thematic analysis. June: 17; 24(1). http://doi:10.1186/s12889-024-19152-y. PMID: 3886691.

[16].  Barnighausen, K., Matse, S., Hughey, A. B., Hettema, A., Barnighausen, T. W., & Machon, S. A., 2020, “We know this will be haard at the beginning, but better in long-term: Understand PrEP uptake in the general population in Eswatini. AIDS Care. http://doi:101080/09540121.2019.1653437. PMID: 31437021.

[17].  Chebet, J. J., Machon, S. A., Tarumbiswa, T., Hlalele, H., Maphonga, C., Mandora, E., Ernst, K., Alaofe, H., Baerninhausen, T., Ehin, J. E., Geldsetzer, P., & Nichler, M., 2023, Motivation for Pre-Exposure Prophylaxis Uptake and Decline in an HIV-Hyperendemic Setting: Finding from a Qualitative Implementation Study in Lesotho. AIDS Res.Ther.2023. Jul6; 20(1):43. http://doi:10.1186/512981.023.00535. PMID: 37415180.

[18].  Muwonge, T. R., Nsubuya, R., Brown, C., Nakyanzi, A., Bagaya, M., Bambia, M. et al., 2020, Knowledge and Barrier of PrEP Among Diverse Groups of potential PrEP uses in Central Uganda. PLOS one.15 (10): e0241399. http://doi.org/101371/journal.pone.024/399

[19].  Sila, J., Larsen, A., KInuthia, J., Owin, G., Abuna, F., Kohler, P., John-Stewart, G., & Pinty, J., 2020, High Awareness, Yet Low Uptake, Pre-Exposure Prophylaxis Among Adolescent Girls and Young Women with Family Planning Clinics in Kenya. AIDS Patient Care STDS.2020 Aug: 34(8):336-343. http://10.1089.apc.2020.0037.PMID: 32757980.

[20].  Tietelman, A. M., Hong-van, T., Flores, D., Bannon, J., Brawne, B. M., Davis, A., Gurgerty, P., & Koblin. B., 2021, Individual, Social, and Structural Factors Influencing PrEP Uptake Among CSgender Women: A theory-informed elicitation study. AIDS Care.2021 March 9:34(3):273-283. http://doi:10.1080/09540121.2021.1894319

[21].  Crook, N., Singer, R. B., Smith, A., Donenberg, S. Mathews, A. K., Patil, C. L., Haider, S., & Johnson, A., 2022, Barriers to PrEP Uptake among Black Female Adolescent and Emerging Adults.Science direct. http://doi.org/10.1016/j.pmedr.2022.102062

[22].  Samo, R. N., Jamali, M. S., Mahmood, S. F., Umar, R., Mustafa, K., & Muhamand, S. J., 2025, Understanding Barriers to HIV Pre-Exposure Prophylaxis Initiation Among Men who have Sex with Men in Sindh, Pakistan. International Journal of STD and AIDS. Jul; 36(8):649-654. http://doi.10.1177/09564624251344419. PMID: 40396384.