Provider–client rapport in pre-exposure prophylaxis delivery: a qualitative analysis of provider and client experiences of an implementation science project in Kenya

Daily oral pre-exposure prophylaxis (PrEP) is being incorporated into services frequented by adolescent girls and young women (AGYW) in sub-Saharan Africa who are at a significant risk of HIV. In non-PrEP studies, positive provider–client rapport has been shown to improve patient decision-making and use of medication in clinical care. We examined AGYW and healthcare provider (HCP) perspectives on the value of and strategies for building positive provider–client rapport. We conducted in-depth interviews from January 2018 to December 2019 with 38 AGYW and 15 HCPs from two family planning clinics in Kisumu, Kenya where PrEP was being delivered to AGYW as part of the Prevention Options for Women Evaluation Research (POWER) study. We used semi-structured interview guides and audio-recorded interviews with participant consent. Verbatim transcripts were analysed using thematic content analysis. HCPs and AGYW emphasised the importance of positive provider–client rapport to meet AGYW support needs in PrEP service delivery. HCPs described how they employed rapport-building strategies that strengthened AGYW PrEP uptake and continuation, including: (1) using friendly and non-judgmental tones; (2) maintaining client confidentiality (to build client trust); (3) adopting a conversational approach (to enable accurate risk assessment); (4) actively listening and tailoring counselling (to promote client knowledge, skills, and self-efficacy); and (5) supporting client agency. Positive provider–client relationships and negative experiences identified in this analysis have the potential to facilitate/deter AGYW from using PrEP while at risk. The strategies to enhance provider–client rapport identified in this study could be integrated into PrEP provider training and delivery practices. En Afrique subsaharienne, la prophylaxie préexposition par voie orale (PrEP) quotidienne est intégrée dans les services fréquentés par les adolescentes et les jeunes femmes à risque important de contracter le VIH. Les études ne portant pas sur la PrEP ont montré qu’une relation positive entre le prestataire et le client améliore la prise de décision des patients et l’emploi des médicaments dans les soins cliniques. Nous avons examiné les perspectives des adolescentes et des jeunes femmes ainsi que des prestataires de soins de santé sur l’utilité de l’établissement de relations positives entre les prestataires et les clients et sur les stratégies pour y parvenir. Nous avons mené des entretiens ap