Preferences, educational messaging, and demand creation channels for multipurpose-prevention technologies (MPTs) among women in South Africa

Abstract

Background South African women, including female sex workers (FSWs), are disproportionately affected by HIV, experience a high unmet need for contraception and high rates of sexually transmitted infections (STIs). Products that address the interlinked risk between HIV, unplanned pregnancy, and other STIs are needed. There are several multipurpose-prevention technologies (MPTs) in development, aimed at preventing both HIV and pregnancy. This study aimed to explore educational messaging and demand creation channels to improve the potential uptake of a hypothetical MPT implant, using participatory action research. It also aimed to look at product and service provision attributes preferred by potential end users. Methods Between July and August 2022, 303 PrEP-eligible adolescent girls and young women (AGYW) (18–24 years), women > 24 years, and FSW’s (≥ 18 years) participated in 4-hour workshops, where they were asked about their ideal messaging and demand creation channels and their preferences for different attributes of an MPT implant. Quantitative descriptive analysis was conducted to determine the frequency and ranking for each demand creation message, channel, and each product and service provision attribute, by population group. A chi-square test was used to assess MPT implant characteristics associated with age. Qualitative data were analysed using deductive and thematic analysis. Results A total of 104 AGYW, 157 women > 24 years, and 42 FSWs participated in the PAR workshops. Participants preferred demand creation messages that were empowering, motivational and encouraged body autonomy. The use of slang was popular. Community radio stations and newspapers, social media, and information at hospitals and clinics were participants’ preferred MPT demand creation channels because they were easily accessible. Providing long-term and dual HIV and pregnancy protection, receiving implant services at the local clinic, manageable side effects, discreet and private implant, and numbing the area before insertion and removal, were the most preferred product and service provision attributes. Conclusion Early considerations for women’s product preferences are key to product development. Educational messaging around the MPT implant should be empowering and in local languages, this may motivate women to learn more about it and use it. Multiple demand creation channels should be used to engage both young and older populations, which may ensure better reach.

Key programmatic and policy considerations for introducing multipurpose prevention (MPT) methods: reflections from healthcare providers and key stakeholders in South Africa

“…A variety of demand creation methods (in-person, IEC materials, billboards and radio as well as online platforms) should be employed, seeking to reach as many people as possible. This is supported by Mataboge et al ( 23 ). HCPs recognise that young people would like information in a language appealing to them, from someone who understands their needs, like a peer educator ( 40 , 41 ).…”

“…This reinforces the need for accurate information sharing and demand creation, especially about the composition of the implant. Mataboge et al ( 23 ), presenting findings from another objective of this research study, highlights the various demand creation tactics and messages that were appealing to potential end users when MPT methods are closer to implementation. Further engagements with potential end users, local community groups and key stakeholders should be held to build on our research findings.…”

“…Healthcare providers (HCPs) are key gatekeepers at various levels of health system governance and healthcare service provision ( 22 ). In South Africa, HCP attitudes are a known barrier to healthcare uptake ( 23 ) but evidence shows that actively engaging them when planning and implementing major health programmes improves both health outcomes and the health system ( 24 , 25 ). Lanham et al (2011) researched 113 HCPs at 36 public, private, and non-governmental health facilities in South Africa, Zimbabwe and Kenya that were offering PrEP.…”

“…We also sought to understand the policy and programmatic considerations for adopting alternative PrEP options from the perspective of key South African stakeholders (facility and district managers and technical leads). This research was part of a larger formative research project aiming to estimate the potential uptake of a hypothetical MPT implant to inform product development ( 23 , 27 ).…”