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These included 36 adolescent girls and young women aged 15\u201324 years and adolescent boys and young men aged 15\u201335 years who initiated PrEP within one month at various service delivery points, including clinics, schools, and community-based services. An additional 12 participants who had not initiated PrEP were also included. Data were analysed thematically using a comprehensive codebook developed to guide the coding process. All transcripts and audio recordings were validated for completeness and accuracy before coding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The study identifies critical factors that support successful PrEP implementation and expansion among high-risk, sexually active AYAs. The PHC re-engineering programme emerged as a crucial strategy for increasing both PrEP uptake and adherence. Participants expressed a strong preference for decentralised service models, including community-based facilities, outreach teams, and home delivery systems. These models were most appealing to AYAs compared to traditional healthcare facilities. They effectively addressed common barriers such as long waiting times, unfriendly healthcare professionals, overcrowding, stigma, and transportation challenges. Some participants noted that home delivery of PrEP saved both time and money, contributing to better adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Decentralised, community-based approaches play a vital role in improving PrEP uptake, adherence, and continuation among AYAs in South Africa. The findings underscore the importance of addressing key barriers such as distance, stigma, and accessibility. By decentralizing PrEP services and embedding them within familiar, youth-friendly spaces at community level, this study demonstrates how HIV prevention can be made more accessible and acceptable to AYAs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-025-25698-2","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T06:15:18Z","timestamp":1766384118000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A primary health care Re-Engineering approach to enhance PrEP initiation and adherence among high-risk, sexually active adolescents and young adults in KwaZulu-Natal, South Africa"],"prefix":"10.1186","volume":"25","author":[{"given":"Thubelihle","family":"Mathole","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine Uwimana","family":"Nicol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mbuzeleni","family":"Hlongwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3722-1547","authenticated-orcid":false,"given":"Eunice","family":"Turawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-1858","authenticated-orcid":false,"given":"Wisdom","family":"Basera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noluntu","family":"Funani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6019-9259","authenticated-orcid":false,"given":"Edward","family":"Nicol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"25698_CR1","doi-asserted-by":"publisher","DOI":"10.18356\/9789211066135","volume-title":"People living with HIV \u2014 Thematic briefing note \u2014 2024 global AIDS update The Urgency of Now: AIDS at a Crossroads","author":"UNAIDS","year":"2024","unstructured":"UNAIDS. 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Gatekeeper approvals were also obtained from the districts, facilities, and collaborating Provincial Department of Health (Ref: KZ_202010_033).A waiver of parental consent was also granted by the SAMRC Human Research Ethics Committee for participants aged 15\u201317 to facilitate their involvement (Supplementary file 2), although the informed consent process and documentation were identical to those used for participants aged 18 and above.Prior to participation, all potential participants received both oral and written informed consent in line with the Declaration of Helsinki (1964). Confidentiality and privacy were strictly maintained by using study codes in place of participants\u2019 personal information across all records. Audio recordings and transcripts were securely stored at the SAMRC in a password-protected file. Given the sensitive nature of the study, referral resources were provided to participants experiencing emotional distress during interviews. Interviewers also received weekly debriefing sessions to their well-being and address any challenges encountered during the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"4308"}}