Knowledge, attitudes, and willingness of healthcare workers to offer pre-exposure prophylaxis in Africa: a systematic review and meta-analysis.

Abstract

Background: Despite advancements in HIV prevention strategies, including pre-exposure prophylaxis (PrEP), uptake remains suboptimal in high-burden regions like Africa. Healthcare workers (HCWs) play a pivotal role in PrEP implementation. This study systematically reviews the scientific literature to evaluate the knowledge, attitudes, and willingness of healthcare workers in offering pre-exposure prophylaxis (PrEP) in Africa.

Methods: This systematic review and meta-analysis followed PRISMA guidelines, synthesizing qualitative and quantitative studies from PubMed, Cochrane CENTRAL, and Google Scholar (2010-2024). We included studies that assessed HCWs' PrEP-related knowledge, attitudes, and willingness in African settings. Pooled proportions for key outcomes were calculated using random-effects models, and barriers/facilitators were thematically analyzed.

Results: Of 293 screened records, 34 studies conducted in 12 countries were included. Meta-analysis revealed high PrEP awareness (85%, 95% CI: 75-91%) but poor knowledge (18%, 95% CI: 4-55%). Attitudes were moderately positive (46%, 95% CI: 25-68%), and willingness to prescribe PrEP was 58% (95% CI: 43-72%). Key barriers included stigma, inadequate training, workload, concerns about risk compensation, and health system constraints. Facilitators included provider training, experience, and integrated service delivery.

Conclusion: While PrEP awareness is high among African HCWs, knowledge gaps and attitudinal barriers hinder optimal implementation. Targeted interventions-such as structured training, stigma reduction, and health system strengthening-are critical to enhancing PrEP adoption. Future research should explore context-specific strategies to improve HCW engagement in PrEP programs.