Preferences for long‐acting Pre‐Exposure Prophylaxis (PrEP) for HIV prevention among South African youth: results of a discrete choice experiment

Abstract

IntroductionExisting biomedical HIV prevention options, though highly effective, present substantial adherence challenges. End‐user input on early‐stage design of new HIV prevention approaches is critical to yielding products that achieve high uptake and adherence. The iPrevent Study examined youths’ preferences for key attributes of long‐acting Pre‐Exposure Prophylaxis (PrEP), with a focus on characteristics pertinent to product delivery alongside key modifiable product attributes.MethodsA discrete choice experiment was conducted with female and male youth aged 18 to 24 in two high‐density communities in Cape Town, South Africa during the period July 2017 to January 2019. Sexually active, PrEP‐naïve youth were recruited using population‐based sampling; targeted sampling was used to enrol men who have sex with men (MSM). In a series of nine questions, participants were asked to choose between two hypothetical products composed of five attributes (form, dosing frequency, access, pain, insertion site). We used a random‐parameters logit model to estimate preference weights and trade‐offs among product alternatives. We examined differences across three subgroups: females, men who have sex with only women (MSW) and MSM.ResultsA total of 807 participants (401 female) were enrolled with a median age of 21 years. Males included 190 MSM. Most youth had tested for HIV (95%) and reported being HIV‐negative (91%). Across all groups, duration of effectiveness was the most important attribute, with strong preference for less frequent dosing. Injections were favoured over implants, though these preferences were strongest for females and MSM. Females preferred a product offered at a health clinic and disliked pharmacy access; all groups preferred the arm as the insertion site. Youth were willing to trade their preferred product form for longer duration.ConclusionsYouth indicated strong preferences for longer duration products. Each attribute nonetheless influenced preferences, offering insight into trade‐offs that inform long‐acting PrEP development.

An open‐label, randomized crossover study to evaluate the acceptability and preference for contraceptive options in female adolescents, 15 to 19 years of age in Cape Town, as a proxy for HIV prevention methods (UChoose)

“…There was high inter‐individual variability amongst preferences, underscoring the need for a menu of HIV prevention options, including oral PrEP, vaginal rings, male and female condoms, as well as regular testing and injectable PrEP when available. These results are consistent with the findings of other studies of product preference conducted in young African women [21‐23]. It is also likely that these needs and preferences might change over time as adolescents’ transition to young adulthood.…”

“…Easy transitions from one option to another would be ideal. It is possible that the efficacy of a product in the prevention of HIV may also affect decision making when these products become available as other studies have reported that highly effective products are more important than other attributes [21][22][23].…”

A qualitative study to identify critical attributes and attribute-levels for a discrete choice experiment on oral pre-exposure prophylaxis (PrEP) delivery among young people in Cape Town and Johannesburg, South Africa

“…Permission was granted from the iPrevent study team to utilize illustrations for public community health clinic and private pharmacy as part of our DCE choice sets [ 34 ]. For the other illustrations the following sources are acknowledged: Daily PreP [ 35 ]; on-demand PrEP [ 36 ]; cost illustrations [ 37 , 38 ]; nausea [ 37 ]; headache [ 39 ]; rash [ 40 ] …”

A qualitative study to identify critical attributes and attribute-levels for a Discrete Choice Experiment on oral Pre-Exposure Prophylaxis (PrEP) delivery among young people in Cape Town and Johannesburg, South Africa.

“…Permission was granted from the iPrevent study team to utilize illustrations for public community health clinic and private pharmacy as part of our DCE choice sets [36]. For the other illustrations the following sources are acknowledged: Daily PreP [37]; on-demand PrEP [38]; cost illustrations [39,40]; nausea [39]; headache [41]; rash [42] Pilot testing of the DCE with Community Advisory Board Members…”