Giving voice to the end-user: input on multipurpose prevention technologies from the perspectives of young women in Kenya and South Africa

Abstract

Unintended pregnancy and unmet need for modern contraception contribute substantially to reproductive health disparities globally. In sub-Saharan Africa they occur in contexts of disproportionately high rates of HIV infection. Multipurpose prevention technologies (MPTs) can address HIV and pregnancy prevention needs in a single "2-in-1" product; however, few studies have solicited end-user views to inform design of new MPTs. We conducted the Tablets, Ring, Injections as Options (TRIO) study with young women aged 18−30 in Kenya and South Africa (N = 277) to examine preferences and acceptability of future MPTs. In a randomised clinical cross-over study in which women used three placebo delivery forms, we complemented quantitative acceptability assessments with in-depth interviews and focus group discussions (N = 88 participants). We examined anticipated enablers and barriers to adoption and use of future MPTs and synthesised novel product design recommendations. Participants expressed high interest in MPTs. Anticipated side effects constituted a primary concern; however, many expected barriers were not dosage form-specific, but addressed contextual factors instead, such as fears regarding use of new biomedical technologies, misunderstandings and stigma regarding use, and navigating partner disclosure and engagement. Women preferred MPTs that offered discreetness and long-duration protection to minimise user-burden, did not interfere with their relationships, and conferred protection for unanticipated situations. End-user research to identify and pre-emptively address potential barriers while underscoring benefits to a new MPT product is vital. Attention to cultural contexts in implementation of new MPTs is important to communicating perceived benefits, achieving acceptability and maximising public health benefits.

Multipurpose Prevention Technologies: Oral, Parenteral, and Vaginal Dosage Forms for Prevention of HIV/STIs and Unplanned Pregnancy

“…Additionally, 41% of women who used short-acting modern methods (e.g., pills and condoms) discontinued their use due to side effects and the facile capability of discontinuation [ 9 ]. Overall, poor adherence to HIV/STI and contraceptive regimens remains high due to side effects, inconvenient dosing schedules, poor access to products, cost, low education level [ 20 , 21 ], or poor familiarity with products [ 20 , 21 ], and/or negative stigma, ultimately resulting in poor product efficacy [ 22 , 23 ].…”

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)

“…Male partners were most concerned with limiting side effects impacting sexual pleasure (changes in menstrual bleeding and vaginal dryness), female partners were most concerned with limiting side effects causing physical symptoms (headaches, stomach pain and heavy bleeding) and both were concerned with the return to fertility. Though our results reflect known gender‐based barriers to contraceptive uptake [ 55 , 56 , 57 ], they add valuable context to the existing literature on MPT product preferences which has largely excluded the perspective of male partners [ 21 , 58 , 59 , 60 , 61 , 62 ], who often wield considerable influence in couple‐based sexual and reproductive health decision‐making in the region [ 32 , 39 , 53 , 63 , 64 , 65 ]. Our results also highlight the need for future MPTs to align with gendered product attribute preferences and the need for future MPT messaging to be clear about product side effects.…”

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

“…The MPT design options presented, which included vaginal rings, fast-dissolving vaginal inserts and films, and oral tablets, were preferred over male condoms by nearly all couples. Although the strong interest in MPTs aligns with other studies conducted among women [ 3 , 14 ], we have few data from men and couples directly about their views of MPTs, including their preferences among key attributes of MPT products in development. A substantial body of HIV prevention and contraceptive research has highlighted the key influence that male partners exert over women’s choice and use of HIV and pregnancy prevention in many settings; likewise, many women would like to engage their partners jointly in these decisions.…”

“…Multipurpose prevention technologies (MPTs), which offer protection against unintended pregnancy, HIV, or other sexually transmitted infections in a single product, stand to address multiple sexual and reproductive health needs simultaneously. Importantly, MPTs have the potential for increased acceptability and use relative to single indication products, for reasons that include improved access through delivery of an integrated product with fewer clinic visits, reduced stigma tied to accessing and using HIV prevention, ease of use, and expanded choice in the available method mix [ 3 – 5 ].…”