Couples’ Preferences for “2 in 1” Multipurpose Prevention Technologies to Prevent Both HIV and Pregnancy: Results of a Discrete Choice Experiment in Uganda and Zimbabwe

Minnis, Alexandra; Etima, Juliane; Musara, Petina; Browne, Erica N.; Mutero, Prisca; Kemigisha, Doreen; Mgodi, Nyaradzo; Nakabiito, Clemensia; Shapley‐Quinn, Mary Kate; Stoner, Marie; Hartmann, Miriam; Macagna, Nicole; Piper, Jeanna; Straten, Ariane van der

doi:10.1007/s10461-022-03713-6

Cited by 12 publications

(26 citation statements)

References 34 publications

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“…Participants also viewed MPTs as a product for improved sexual and reproductive health protection and reported that an MPT's overall purpose was more important than product-specific attributes ( 20 , 23 , 31 , 34 , 40 , 46 , 47 , 52 ). Few studies reported reasons for not preferring MPTs; however, those that did noted the primary reason was a desire to conceive, retaining the option for flexibility, or concerns with drug toxicity ( 42 , 45 , 47 , 52 ).…”

Section: Resultsmentioning

confidence: 99%

“…For example, women who had previously used contraceptive implants or an IUD expressed a higher preference for the ring, women who had previously used birth control pills expressed a higher preference for the tablet, and women with only condom experience expressed a higher preference for films, inserts, and diaphragms ( 39 , 50 ). Lastly, TRIO participants cited a lack of familiarity with new biomedical technologies as an important consideration with MPT introduction ( 42 ).…”

Section: Resultsmentioning

confidence: 99%

“…Frequency of administration or duration of use was a salient aspect of product acceptability for end users, and, when assessed, for their partners ( 26 – 28 , 30 , 40 , 42 , 51 ). Across studies and products, end users expressed a range of preferences for an ideal dosing frequency that most often ranged from 1 month to 1 year, with the ideal target duration varying by delivery form, study population, and location ( 6 , 18 , 19 , 27 , 28 , 30 , 32 , 38 , 40 – 43 , 46 , 50 , 51 ).…”

Section: Resultsmentioning

confidence: 99%

“…Other end users raised concerns about long-acting products with infrequent dosing such as forgetting to re-administer products at the appropriate time, particularly user-controlled methods that required vaginal insertion monthly ( 6 ), and unknown health impact of long-acting product use ( 6 , 51 ). A smaller proportion of end users noted that event-driven dosing was an appealing option for people who engaged in infrequent sexual activity ( 29 , 42 ). End users who engaged in vaginal sex more frequently had lower preference for a product administered before sex, whereas end users who engaged in less frequent sex had lower preference for a product administered daily ( 26 ).…”

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%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

Self Cite

View full text Add to dashboard Cite

show abstract

Making the Case for Joint Decision‐Making in Future Multipurpose Prevention Technology (MPT) Choice: Qualitative Findings on MPT Attribute Preferences from the CUPID Study (MTN‐045)

et al. 2022

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Introduction Young women in sub‐Saharan Africa account for two‐thirds of all new HIV infections and face high rates of unintended pregnancy. Multipurpose prevention technologies (MPTs) are promising products under development that are designed to simultaneously prevent HIV and unintended pregnancy. Since MPTs will be used in the context of sexual relationships, ensuring acceptability and use requires understanding the role of male partners in MPT use decision‐making. Methods This paper draws on qualitative data from 39 couples enrolled in the Microbicide Trials Network (MTN) 045 study, conducted in 2019–2020. Partners completed a discrete choice experiment (DCE), first separately and then jointly, to measure preferences for future MPT attributes and then completed a qualitative interview. We also draw on quantitative data from interviewer observation about who dominated the decision‐making process during the joint DCE. Content analysis was used to examine (1) how couples made decisions on existing non‐MPT HIV and pregnancy prevention products; (2) how couples made decisions on future ideal‐MPT product during the DCE; and (3) how these decision‐making processes varied by decision‐making dominance (10 male, 10 female and 19 equal) and interview type (19 joint and 20 separate). Results Existing non‐MPT product decisions focused on trust between partners and product attributes, while future ideal‐MPT product decisions exclusively focused on product attributes. Across existing and future products, preferences for product attributes varied by gender. Male partners were most concerned with limiting side effects impacting sexual pleasure, female partners were most concerned with limiting side effects causing physical symptoms and both were concerned with the return to fertility. Across all dominance and interview types, couples reported making decisions together and female partners were often able to negotiate with male partners for their preferred product or set of product attributes. Conclusions Research activities in this study provided an opportunity for couples to openly present their product attribute preferences to their partner, learn about their partner's attribute preferences, negotiate for their ideal set of attributes and ultimately choose attributes that benefited the couple without disempowering the female partner. Future research should focus on the utility of couple‐based decision‐making aids or similar tools for facilitating joint MPT decision‐making.

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Effective preexposure prophylaxis in young women and girls, a key population for HIV prevention

Rousseau,

Bennin,

Bekker

2024

Current Opinion in HIV and AIDS

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Purpose of review Although there is substantial momentum to scale up preexposure prophylaxis (PrEP) for HIV prevention in adolescent girls and young women (AGYW) at risk of HIV acquisition, this key population has demonstrated difficulty in sustained PrEP use. Despite being a user-controlled and discreet prevention option, effective oral PrEP use requires a series of complex daily decisions in the life of the PrEP user. In this review, we describe how the number of decisions AGYW have to execute for effective and continued PrEP use may potentially be reduced by providing simplified, integrated, differentiated sexual and reproductive health services that include PrEP, and introducing a choice of PrEP products, including less frequently dosed, longer acting and/or multipurpose prevention technology (MPT) products. Recent findings PrEP uptake and effective use are enhanced when AGYW experience PrEP service delivery channels as convenient, integrated with their other sexual and reproductive health needs and matching their experiences (including limited autonomy) and lifestyle. Longer acting or less frequently dosed PrEP products or MPTs may reduce the cognitive burden associated with prevention decision-making and is, therefore, likely more suitable for the majority of AGYW who struggle with daily pill adherence. Summary In the scaling up of HIV prevention for AGYW, implementers are encouraged to consider both PrEP products and PrEP delivery outlet preferences. Understanding and responding to AGYW's different needs will allow for preferred PrEP delivery outlets and choice in PrEP products, leading to a greater likelihood of effective PrEP use in this key population.

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Couples’ Preferences for “2 in 1” Multipurpose Prevention Technologies to Prevent Both HIV and Pregnancy: Results of a Discrete Choice Experiment in Uganda and Zimbabwe

Cited by 12 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

Making the Case for Joint Decision‐Making in Future Multipurpose Prevention Technology (MPT) Choice: Qualitative Findings on MPT Attribute Preferences from the CUPID Study (MTN‐045)

Effective preexposure prophylaxis in young women and girls, a key population for HIV prevention

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