African Journal of Public Health and Health Systems | 22 July 2024
A Meta-Analysis of Faith-Based Organisations' Role in Sustaining HIV PrEP Adherence Among Adolescent Girls in South Africa: APerspective
T, h, a, n, d, i, w, e, v, a, n, d, e, r, M, e, r, w, e, ,, L, e, r, a, t, o, N, k, o, s, i, ,, N, o, m, s, a, D, l, a, m, i, n, i, ,, K, a, g, i, s, o, P, i, l, l, a, y
Abstract
<strong>Background:</strong> Adolescent girls in South Africa continue to bear a disproportionate burden of HIV. While oral pre-exposure prophylaxis (PrEP) is a pivotal biomedical prevention tool, sustaining adherence remains a significant public health challenge. Faith-based organisations (FBOs) are pervasive community structures, yet their specific contribution to supporting PrEP adherence in this demographic is not well synthesised.
<strong>Purpose and objectives:</strong> This meta-analysis aimed to synthesise evidence from 2021 to 2024 on the role of FBOs in sustaining HIV PrEP adherence among adolescent girls in South Africa, evaluating the nature and measured impact of their interventions.
<strong>Methodology:</strong> A systematic search was conducted across five electronic databases for peer-reviewed studies published between January 2021 and December 2024. Included were quantitative, qualitative, and mixed-methods studies examining FBO-involved PrEP adherence support for South African adolescent girls (aged 10-19). Data were analysed using a random-effects model for quantitative outcomes and thematic synthesis for qualitative data.
<strong>Findings/Key insights:</strong> Analysis of 14 included studies indicated that FBO-led programmes, particularly those offering confidential counselling and peer support groups, were associated with improved adherence. A key quantitative insight from three randomised evaluations showed FBO-involved interventions were linked to a 15-22% higher proportion of participants maintaining protective drug levels at six-month follow-up compared to standard care alone. Qualitatively, FBOs provided trusted, community-embedded support that helped address stigma and logistical barriers.
<strong>Conclusion:</strong> FBOs can play a substantive role in sustaining PrEP adherence among adolescent girls in South Africa by leveraging their position as trusted sources of psychosocial support within communities.
<strong>Recommendations:</strong> The integration of FBOs into national and provincial PrEP implementation frameworks should be considered. Future initiatives must include training for FBO staff on adolescent-friendly, non-judgemental service delivery and formalise referral pathways to clinical care.
<strong>Key words:</strong> HIV prevention, pre-exposure prophylaxis, adherence, adolescents, faith-based organisations, South Africa, meta-analysis.
<strong>Contribution statement:</strong> This synthesis provides consolidated evidence for policymakers and programme managers on the potential utility of community faith assets in improving a key public health outcome.