Preferences and Acceptability for Long-Acting PrEP Agents Among Pregnant and Postpartum Women with Experience Using Daily Oral PrEP in South Africa and Kenya

Wara, Nafisa J.; Mvududu, Rufaro; Marwa, Mary; Gómez, Laurén; Mashele, Nyiko; Orrell, Catherine; Moucheraud, Corrina; Kinuthia, John; John‐Stewart, Grace; Myer, Landon; Hoffman, Risa M.; Pintye, Jillian; Davey, Dvora Joseph

doi:10.1101/2022.10.29.22281701

Cited by 6 publications

(16 citation statements)

References 45 publications

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Section: Resultsmentioning

confidence: 99%

“…Product duration was the most important factor driving user preferences in many studies across demographics [7,10,12,23,28]. Oral PrEP-experienced pregnant and postpartum women most commonly cited product duration as a factor for switching to LAI [12]. Oral PrEP-experienced men also frequently reported difficulty adhering to a daily dosing schedule, especially on weekends, as well as difficulty swallowing the pill itself [7].…”

Section: Resultsmentioning

confidence: 99%

“…Most or all individuals in 11 studies had prior experience with oral PrEP, while nine studies were conducted among exclusively PrEP-naïve participants (Table S2). 10 studies were conducted among individuals participating in randomized clinical trials for PrEP [5][6][7][8][9][10][11], cohort studies [12,13], or PrEP implementation projects [14].…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…In a study of pregnant and postpartum women participating in the PrEP-PP and PrIMA-X trials in South Africa and Kenya, respectively, many voiced safety concerns for the mother and infant during pregnancy and breastfeeding. These women, most of whom had recent experience with oral PrEP, tended to prefer long-acting products over daily oral for their longer duration (especially in South Africa) and increased discretion (especially in Kenya) [12]. All pregnant AGYW interviewed in a study in South Africa would not use the DVR on account of perceived side effects [16].…”

Section: Womenmentioning

confidence: 99%

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User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

Pfau,

Saravis BA,

Cox

et al. 2024

Preprint

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Structured AbstractBackgroundNovel formulations for PrEP such as injectables, implants, and intravaginal rings are emerging as long-acting alternatives to daily pills for the prevention of HIV. Sub-Saharan Africa has the highest HIV burden as well as the highest PrEP coverage globally. As long-acting formulations continue to become available, it is crucial to understand the product preferences of potential users.ObjectiveTo conduct a scoping review focused on the region of Sub-Saharan Africa to understand which PrEP products, especially long-acting formulations, different patients and demographic groups prefer as well as the factors that influence their preferences.DesignWe identified 34 publications published between 2014 and 2024 that assessed preferences regarding at least one long-acting PrEP product in the region of Sub-Saharan Africa.ResultsParticipants preferred longer-acting products over oral pills when given the choice in almost all studies. On-demand PrEP was commonly preferred over daily dosing, and long-acting products were preferred over on-demand dosing. A majority of studies found injectables to be most commonly preferred compared to daily oral PrEP, implants, and rings. This preference was observed across a range of demographics including men and women, youth, men who have sex with men, and female sex workers. Duration, efficacy, and discretion were the three most important factors influencing participants’ choices.ConclusionsLong-acting products, especially injectables, are acceptable for a wide range of individuals at risk of HIV in Sub-Saharan Africa and tend to be preferred over daily oral pills. Participants expressed a diversity of values and opinions regarding preferences, emphasizing the benefit of providing multiple formulations to maximize coverage over heterogeneous populations.Strength and Limitations of this StudySome key populations, such as transgender women, were underrepresented in the literature. With most studies published before long-acting products became widely available, the hypothetical preferences of non-experienced users may differ from preferences in practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Womenmentioning

confidence: 99%

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User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

Pfau,

Saravis BA,

Cox

et al. 2024

Preprint

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“…Our updated model has been parameterized using recent data from a PrEP cohort study conducted among pregnant and postpartum women in South Africa, which shows reasonable oral PrEP uptake but limited adherence and continuation [5,7,15]. In this context, CAB-LA could potentially be very important, reducing HIV incidence in PBW by around 40%, and reducing vertical transmission by around 24% -a reflection of both greater acceptability of injectable prevention methods [22][23][24] and superior efficacy [9]. Offering a choice of CAB-LA and oral PrEP would lead to the greatest PrEP uptake (consistent with the effect of choice in family planning [25]), but the impact on HIV transmission would not differ materially from offering CAB-LA alone.…”

Section: Discussionmentioning

confidence: 99%

The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants

Johnson,

Myer,

Jamieson

et al. 2023

Aids

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Background: Pregnant and breastfeeding women (PBW) in sub-Saharan Africa have high HIV incidence rates and associated risk of vertical transmission to their infants. Oral pre-exposure prophylaxis (PrEP) and injectable PrEP (long-acting cabotegravir, or CAB-LA) can potentially reduce this HIV transmission, but population-level impacts are uncertain. Methods: We extended a previously-developed model of HIV and PrEP in South Africa to allow for variable PrEP duration and preference in PBW. We considered three potential scenarios for PrEP provision to PBW: oral PrEP only, CAB-LA only and allowing oral/CAB-LA choice, with uptake and retention assumptions informed by South African data, each compared to a ‘base’ scenario without PrEP for PBW. Results: Without PrEP for PBW, the model estimates 1.31 million new infections will occur between 2025 and 2035 in South African adults and children, including 100,000 in PBW, 16,800 in infants at/before birth, and 35,200 in children through breastmilk. In the oral PrEP only scenario, these numbers would reduce by 1.2% (95% CI: 0.7–1.7%), 8.6% (4.8–12.9%), 4.0% (2.1–5.8%) and 5.3% (3.0–8.2%) respectively. In the CAB-LA only scenario, the corresponding reductions would be 6.1% (2.9–9.6%), 41.2% (19.8–65.0%), 12.6% (6.0–19.4%) and 29.5% (13.9–46.8%) respectively, and in the oral/CAB-LA choice scenario, similar reductions would be achieved (5.6% [3.4–8.0%], 39.0% [23.4–55.9%], 12.4% [7.4–16.8%] and 27.6% [16.5–39.9%] respectively). Conclusion: CAB-LA has the potential to be substantially more effective than oral PrEP in preventing HIV acquisition in PBW and vertical transmission, and can also modestly reduce HIV incidence at a population level.

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New Information on Antivirals and Breastfeeding

Anderson

2023

Breastfeeding Medicine

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Preferences and Acceptability for Long-Acting PrEP Agents Among Pregnant and Postpartum Women with Experience Using Daily Oral PrEP in South Africa and Kenya

Cited by 6 publications

References 45 publications

User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants

New Information on Antivirals and Breastfeeding

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