Incorporating End-Users’ Voices into the Development of an Implant for HIV Prevention: A Discrete Choice Experiment in South Africa and Zimbabwe

Abstract

Background. Input from end-users during preclinical phases can support market fit for new HIV prevention technologies. With several long-acting pre-exposure prophylaxis (PrEP) implants in development, we aimed to understand young women’s preferences for PrEP implants to inform optimal design.Methods. We developed a discrete choice experiment and surveyed 800 young women in Harare, Zimbabwe and Tshwane, South Africa between September-November 2020. Women aged 18 to 30 years who were nulliparous, postpartum, or exchanged sex in prior year were eligible. The DCE asked participants to choose between two hypothetical implants for HIV prevention in a series of nine questions. Implants were described by: size, number of rods and insertion sites, duration (6-months, 1-year, 2-years), flexibility, and biodegradability. Random-parameters logit models estimated preference weights.Results. Median age was 24 years (interquartile range 21-27). By design, 36% had used contraceptive implants. Duration of protection was most important feature, with strong preference for a 2-year over 6-month implant. In Zimbabwe, the number of rods/insertion sites was second most important and half as important as duration. Nonetheless, to achieve an implant lasting 2-years, 74% were estimated to accept two rods, one in each arm. In South Africa, preference was for longer, flexible implants that required removal, although each of these attributes were one-third as important as duration. On average, biodegradability and size did not influence Zimbabwean women’s choices. Contraceptive implant experience and parity did not influence relative importance of attributes.Conclusions. While duration of protection was a prominent attribute shaping women’s choices for PrEP implants, other characteristics related to discreetness were relevant. Optimizing for longest dosing while also ensuring minimal detection of implant placement seemed most attractive to potential users.

Ultra-long-acting refillable nanofluidic implant confers full protection against SHIV infection in non-human primates

“…( 70 ) In some women, biodegradability raised concerns of where the implant goes in the body as it dissolves. ( 71, 72 ) Moreover, healthcare providers prefer palpability for removal, if necessary, which could also assure end-users that the implant has not migrated. ( 73, 74 ) However, palpability could be a challenge for discretion; thus, optimizing implant design and placement are key factors to consider for improving acceptability.…”