ArticleBMC health services research2026
HIV pre-exposure prophylaxis service delivery among young women at increased risk for HIV acquisition in South Africa: a time-and-motion study.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPrEP uptake and continuation among women in sub-Saharan Africa, including adolescent girls, young women (AGYW), and female sex workers (FSW), remains suboptimal. Societal costs, like lost wages and time, are potential barriers. This study assessed the time and resources spent by patients and provider for PrEP-related care including HIV testing, STI screening, PrEP counseling, and prescription management of PrEP among AGYW and FSW in South Africa, exploring factors that may affect PrEP uptake and continuation.
methodsWe conducted a cross-sectional time and motion study, representing a quantitative method used to assess the duration required to complete a defined series of tasks, at 13 decentralized PrEP service sites across nine districts in South Africa. The study measured time spent by clients (AGYW and FSW) receiving PrEP services and by healthcare providers delivering care. Wilcoxon rank-sum tests compared service durations, and opportunity costs (wages lost due to time receiving PrEP services) were estimated for all FSW.
resultsThe study included 148 participants (40% AGYW, 60% FSW). The median time for PrEP services was 25 min (IQR: 14-38). AGYW spent a median of 33 min (IQR: 21-53.5), and FSW spent 22 min (IQR: 13-33), (p = 0.0014). Time was longer for initiation visits (41 min) than refill visits (20 min) (p < 0.0001). Moreover, the median opportunity cost for FSW was 240 ZAR (IQR: 139-358). Lastly, providers spent 13.5-21 min on initiations and 9-27 min on refills.
conclusionsDespite free PrEP access, time and wage costs are significant barriers. Reducing the time commitments could enhance PrEP continuation for AGYW and FSW, though additional strategies for client support and counseling may be needed. Ultimately, improving the efficiency of PrEP delivery may boost PrEP continuation for marginalized women in South Africa.
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