A Scoping Review of Operational Research for Integrating Oral PrEP into Public Sector Family Planning Services in Lilongwe, Malawi

Integrating HIV prevention with family planning services is a strategic priority in high-prevalence settings. Oral pre-exposure prophylaxis is an effective biomedical intervention. Operational research is needed to understand the practicalities of integrating oral PrEP into existing public health systems, specifically within routine family planning clinics in sub-Saharan Africa. This scoping review aimed to map and synthesise existing operational research on integrating oral PrEP services into public sector family planning clinics in Lilongwe, Malawi. Its objective was to identify key themes, operational barriers and facilitators, and evidence gaps to inform future service integration and research. A scoping review was conducted following established frameworks. A systematic search was performed across multiple electronic databases and grey literature sources. Studies were included if they reported on operational aspects of PrEP and family planning integration in the specified setting. Data were extracted and analysed using thematic analysis. The search identified a limited but focused body of operational research. Key findings centred on interconnected themes: client acceptability, healthcare provider training needs, and logistical challenges in supply chain management. A prominent theme was the willingness of family planning clients to adopt PrEP when offered within a trusted service. Identified gaps included a lack of studies on long-term sustainability and cost-effectiveness. Operational research from Lilongwe indicates that integrating oral PrEP into family planning services is feasible and acceptable but faces systemic challenges. The existing evidence provides a foundational understanding but is insufficient to guide scaled, sustainable integration without addressing significant evidence gaps. Future operational research should prioritise implementation science frameworks to evaluate sustainable service delivery models. Studies should investigate strategies for provider capacity building, robust commodity logistics, and cost-analyses. Programmes should use existing findings to design pilot integrations that address identified logistical and training barriers. pre-exposure prophylaxis, service integration, family planning, operational research, Malawi, public health This review consolidates the current operational evidence on PrEP integration within a specific, high-priority setting, clarifying the known barriers and critical knowledge gaps for researchers and programme planners.