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.