Table 1 Summary of study site and participant selection by country

Region selection

Four counties were selected based on high HIV incidence and rural/urban mix: Homabay, Kisumu, Kitui, and Nairobi.

PrEP experienced: Four provinces included: Limpopo, KwaZulu-Natal, Gauteng, and Western Cape. Selection was based on facility rather than region (see below).

PrEP inexperienced: Three sub-districts — located in the provinces of Gauteng, Eastern Cape, and Free State — were selected from priority districts for the She Conquers Campaign^a.

Four of the 10 provinces in Zimbabwe were randomly selected: Harare, Manicaland, Mashonaland West, and Midlands.

Facility selection

Sixteen facilities were selected in consultation with the government for the survey, prioritizing facilities already offering PrEP. Facilities where providers had the highest and lowest scores in each county were selected for inclusion in the IDIs, totaling 13 facilities.

PrEP experienced: Eight facilities providing PrEP (to sex workers and MSM) and 9 facilities that may provide PrEP in the future (university clinics, public facilities) were purposefully selected for a mix of delivery model (fixed clinic, mobile services, or both), rural/urban, and PrEP uptake rate.

PrEP inexperienced: Five facilities with sufficient numbers of eligible survey participants.

Facilities providing ART services to > 50 patients; 26 facilities selected.

Participant selection

Survey participants — all PrEP experienced — with highest and lowest 5 % of attitude scores. Additional providers were selected to ensure that 10 providers were selected from each county.

PrEP experienced: Aimed to conduct at least 3 IDIs per facility.

PrEP inexperienced: Highest and lowest 15 % of attitude scores and all counselors and clinicians due to low number of survey participants from these cadres.

Included both PrEP-experienced and -inexperienced providers. Survey participants with highest and lowest 10 % of attitude scores. Also selected all survey participants currently providing PrEP and 3 additional providers who did not participate in the survey to ensure representation of current PrEP providers.