Perspectives of South African youth in the development of an implant for HIV prevention

Abstract

IntroductionImplants are a new dosage form in development for HIV pre‐exposure prophylaxis (PrEP) with potential for high adherence given that they are provider‐administered and are intended for long‐acting protection. Integrating end‐user preference into early stage product development may further overcome challenges with future product uptake and adherence. Hence, we sought to optimize the design of a PrEP implant in early‐stage development by gathering opinions about implant attributes from potential end‐users in South Africa.MethodsWe conducted 14 focus group discussions (FGDs) with young women and men aged 18 to 24 in Cape Town and Soshanguve, South Africa, inviting participants into discussion as co‐designers. FGDs were homogenous by gender and previous implant experience. During FGDs, we showed prototype devices and followed a semi‐structured guide with questions on history of contraceptive implant use, preferences for physical characteristics of an implant, implant biodegradability, insertion process, participant‐driven ideas for implant design, and social adoption considerations. FGDs were facilitated in English, isiXhosa, Tswana, isiZulu, or Tsonga, audio‐recorded, transcribed into English, and qualitatively coded and analysed.ResultsIn this qualitative sample of 105 youth (68 women and 37 men), 58 participants were from Soshanguve and 47 from Cape Town, and 23% had previously used contraceptive implants. Participants expressed preferences for several implant design features; specifically, longer duration (≥6 months) was more important to most participants than the size or number of devices implanted. A majority preferred a flexible versus stiff implant to minimize palpability, thereby increasing discreetness and comfort. Nearly all participants favoured a biodegradable implant to avoid removal and thus reduce clinic visits. Concerns about the implant centred on its possible side effects and the “plastic” look of the prototype displayed for demonstration.ConclusionsThis study offers preliminary insights into an implant for HIV prevention that provides long‐lasting protection may be well received among young South Africans. Additionally, flexibility, discreetness, and biodegradability may increase acceptability of the implant. Such end–user feedback is being incorporated into current implant designs in the hope of creating an effective long‐acting PrEP product that is likely to achieve high uptake and adherence in target populations.

<p>&ldquo;We are not the same&rdquo;: African women&rsquo;s view of multipurpose prevention products in the TRIO clinical study</p>

“…As described in other studies of preferences for a HIV prevention product,13,33 a major consideration that emerged in TRIO as women described their preferences and choice among the three study products was the desire for a product that reduced the stress women feel about needing to remember to be adherent. Whether it was remembering a daily pill, changing a ring every month, or returning to a clinic periodically for injections, participants expressed concern about the possibility of forgetting, and the ensuing risk to their own health.…”

Design of an Implant for Long-Acting HIV Pre-Exposure Prophylaxis: Input from South African Health Care Providers

“…To ensure consistency in how codes were applied, four inter-rater agreement tests were completed throughout coding on key codes with an average Cohen's kappa statistic of 0.85, considered to be a high level of agreement. 22,23 Analysis was primarily completed through content analysis using a framework matrix-based approach as described previously, 24,25 allowing for large volumes of qualitative data to be distilled and compared across sites.…”

Characterization of a Reservoir-Style Implant for Sustained Release of Tenofovir Alafenamide (TAF) for HIV Pre-Exposure Prophylaxis (PrEP)

“…By increasing the implant wall thickness (e.g., from 70 to 200 µm) using an extrusion method, the implants were more aesthetically pleasing, exhibited greater mechanical sturdiness during handling and therapeutic use, while simultaneously retaining sustained release kinetics of drug. Moreover, the injection end-sealing method presented here produces an implant suitable for commercially available trocars, and is loaded with enough of the drug to last longer than six months; all considerations that were deemed preferable by end-users [67,68]. With an eye towards product development needs for clinical implementation, compatibility with applicators already clinically employed offers options to adopt existing procedures to support LA-PrEP rollout.…”