Acceptability of an intravaginal ring for simultaneously preventing HIV infection and pregnancy: Qualitative findings of the Kisumu Combined Ring Study, 2019

McLellan-Lemal, Eleanor; Deaton, Stacie R.; Betts, Joshua E.; Ondenge, Ken; Mudhune, Victor; O’Connor, Siobhán; Nyagol, Beatrice; Thurman, Andrea Ries; Doncel, Gustavo F.; Allen, Shannon A.; Heffron, Renee; Mugo, Nelly

doi:10.1016/j.cct.2022.106935

Cited by 4 publications

(16 citation statements)

References 34 publications

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“…For example, initial concerns over tablet color and size, and ring insertion and comfort, decreased after the opportunity to use placebo versions of these delivery forms. Similarly, concerns over vaginal insertion of a nanofiber fabric decreased after participants watched the product dissolve ( 6 , 18 , 31 , 35 , 38 , 40 , 51 ). Additionally, ratings and concerns for known and used products such as injectables and tablets changed minimally after demonstrations, educational videos, or actual use ( 6 , 18 , 38 , 51 ), whereas increased exposure to and experience with novel delivery forms increased acceptability ratings and comfort ( 38 , 39 ).…”

Section: Resultsmentioning

confidence: 99%

“…Overwhelmingly, end users preferred products that did not alter their menstrual cycles ( 6 , 29 , 35 , 40 , 42 ), although some preferred lighter menses ( 39 ). Additionally, end users had mixed opinions about using a vaginally-administered product during menstruation, with some noting a dislike of the idea of inserting a product while menstruating; others had concerns about product displacement or reduced efficacy during menstruation ( 25 , 31 ).…”

Section: Resultsmentioning

confidence: 99%

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Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: a scoping review

Bhushan

Ridgeway

Luecke

et al. 2023

Front. Reprod. Health

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IntroductionWomen in sub-Saharan Africa (SSA) experience disproportionately high rates of HIV infection and unintended pregnancy compared to their age-matched counterparts in other regions of the world. Multipurpose prevention technologies (MPTs) that offer protection against HIV and unintended pregnancy in a single product stand to address these dual sexual and reproductive health needs simultaneously. The aim of this scoping review is to identify factors that are important for optimizing the likelihood of MPT adoption by end users in SSA.MethodsStudy inclusion criteria included MPT research (HIV and pregnancy prevention dual indication) published or presented in English from 2000 to 2022 and conducted in SSA amongst end-users (women aged 15–44), male partners, health care providers, and community stakeholders. References were identified by searching peer reviewed literature, grey literature, conference presentations (2015–2022), grant databases, and outreach to MPT subject matter experts. Of 115 references identified, 37 references met inclusion criteria and were extracted for analysis. A narrative synthesis approach was used to summarize findings within and across MPT products.ResultsStudies were identified from six countries in SSA and a substantial proportion included a South African (n = 27) and/or Kenyan (n = 16) study site. Most studies utilized a qualitative study design (n = 22) and evaluated MPT acceptability and preferences by presenting hypothetical products through images or a list of product attributes (n = 21). The vaginal ring (n = 20), oral tablet (n = 20), and injection (n = 15) were examined most frequently. Across studies, there was high acceptability and demand for an HIV and pregnancy prevention MPT. End users valued choice in prevention product type as well as discreetness and long-acting options. Provider counseling and community sensitization were reported as essential for future introduction of novel MPT delivery forms.ConclusionRecognizing the heterogeneity of women's preferences and changing reproductive and sexual health needs over the life course, choice is important in the delivery of pregnancy and HIV prevention products as well as amongst MPT products with distinct product profiles. End user research with active MPTs, vs. hypothetical or placebo MPTs, is necessary to advance understanding of end-user preferences and acceptability of future products.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: a scoping review

Bhushan

Ridgeway

Luecke

et al. 2023

Front. Reprod. Health

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“…Oral PrEP users and participants in studies of oral MPT products express concerns about lack of privacy to take and store pills leading to inadvertent disclosure and ensuing stigma related to PrEP use or assumptions of HIV infection [ 28 , 30 , 34 – 37 ]. While many end users highlight the ability to use vaginal rings discreetly as a positive attribute [ 28 , 33 , 38 ], others express hesitations about the ring being detected by partners during sex [ 28 , 34 , 39 , 40 ]. While contraceptive injections avoid many of these challenges and are, indeed, widely used in sub-Saharan Africa, the first-generation injectable option (CAB-LA) requires reinjection every two months, is painful, and necessitates frequent clinic visits, a potential access barrier [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Prospective acceptability of a multipurpose technology (MPT) implant in preclinical development to prevent HIV and unplanned pregnancy: Qualitative insights from women end users and health care providers in South Africa and Zimbabwe

et al. 2023

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Background Given the high rates of both HIV and unintended pregnancies in sub-Saharan Africa, the SCHIELD program aims to develop a multipurpose technology implant for HIV and pregnancy prevention. An end-user evaluation was undertaken with young women and health care providers to assess preferences for modifiable implant attributes to improve future adoption and rollout. Methods Focus group discussions were conducted with potential women end users, and health care providers experienced in implant insertion or removal participated in in-depth interviews. All participants were recruited from Harare, Zimbabwe, or Soshanguve, South Africa. The purposively stratified sampled women were either implant experienced or implant naïve and were categorized into three groups: nulliparous, postpartum, or engaged in transactional sex. Topics covered included duration (six months to three years), biodegradability, removability, and independent rod retrievability (per indication). Data were analyzed using Dedoose software and summarized into emerging themes. Results Participants identified three key areas that could facilitate rollout, uptake, and adherence of an implant for HIV and pregnancy prevention. First, discreetness was the most salient topic and was associated with implant characteristics such as anatomical location, flexibility, and biodegradability. Second, the ability to independently retrieve the HIV or pregnancy prevention component was preferred, as life circumstances may change and was favored by all participants, except for young women in Soshanguve. Third, there is a need for proper counseling, sensitization, provider training, and health campaigns to facilitate rollout of a 2-in-1 implant. Conclusions A 2-in-1 implant was seen as highly desirable by most young women and health care providers. Participants discussed potential concerns and barriers to uptake of a biodegradable implant with dual HIV prevention and contraceptive properties, identifying key implant attributes that product developers can modify while still in preclinical stages.

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“…These provider and clinic challenges are similar across all types of current PrEP; these also would be likely to exist for future delivery systems including future multi-prevention technologies that may integrate PrEP with STI-prevention and/or contraception. 22,23,25 One way to overcome these challenges would be to ensure that implementation issues are included in the drug research in the first place. For example, rather than studying only the HIV and safety endpoints in a Phase 3 study, protocols could examine service delivery structures to support the specific novel intervention under study.…”

Section: Provider and Clinic Characteristicsmentioning

confidence: 99%

“…10 –21 These are cross-cutting barriers to PrEP uptake, impacting the scale-up of both oral and injectable PrEP agents as well as newer delivery systems expected soon. 22 –25 Knowledge of these barriers allows for planning earlier in the drug-development pathway rather than waiting for a demonstration of efficacy.…”

Section: Introductionmentioning

confidence: 99%

Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis

Magnus,

Yellin,

Langlands

et al. 2023

The Journal of Medicine Access

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HIV prevention with antiretroviral medication in the form of pre-exposure prophylaxis (PrEP) offers a critical tool to halt the HIV pandemic. Barriers to PrEP access across drug types, formulations, and delivery systems share remarkable commonalities and are likely to be generalizable to future novel PrEP strategies. Appreciation of these barriers allows for planning earlier in the drug-development pathway rather than waiting for the demonstration of efficacy. The purpose of this article is to propose a core set of considerations that should be included in the drug-development process for future PrEP interventions. A literature synthesis of key barriers to PrEP uptake in the United States was conducted to elucidate commonalities across PrEP agents and delivery methods. Based on the published literature, we divided challenges into three main categories of structural barriers: (1) provider and clinic characteristics; (2) cost considerations; and (3) disparities and social constructs, with potential solutions provided for each. Pragmatic strategies for examining and overcoming these barriers before future PrEP regulatory approval are recommended. If these strategies are considered well before the time of commercial availability, the potential for PrEP to interrupt the HIV pandemic will be greatly enhanced.

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Acceptability of an intravaginal ring for simultaneously preventing HIV infection and pregnancy: Qualitative findings of the Kisumu Combined Ring Study, 2019

Cited by 4 publications

References 34 publications

Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: a scoping review

Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: a scoping review

Prospective acceptability of a multipurpose technology (MPT) implant in preclinical development to prevent HIV and unplanned pregnancy: Qualitative insights from women end users and health care providers in South Africa and Zimbabwe

Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis

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