Preferences for Long-Acting PrEP Products Among Women and Girls: A Quantitative Survey and Discrete Choice Experiment in Eswatini, Kenya, and South Africa

Abstract

While oral pre-exposure prophylaxis (PrEP) can substantially reduce HIV risk, there are important barriers to uptake and adherence. We explored preferences for long-acting injectable and implantable PrEP among women and girls in Eswatini, Kenya, and South Africa. We conducted an online quantitative survey and discrete choice experiment (DCE) among adolescent girls (15–17), young women (18–29), and adult women (30–49). Participants completed a survey about their demographics and behavior and a DCE with 5 attributes (format, insertion location, number of insertions, dual-protection, and palpability). We recruited 1236 respondents (Eswatini = 420; Kenya = 350; South Africa = 493) in May 2022. Most participants were sexually active (72%), nearly 29% of whom reported recently engaging in transactional sex. 46% had heard of oral PrEP, but of those, only 16% reported having ever used it. Product format and dual-protection were significant predictors of product choice. Relative to a 2-month injection, participants had 1.76 times the odds (95% CI 1.08–2.04) of choosing a 6-month injectable, and 1.70 the odds (95% CI 1.06–1.92) of choosing a 12-month removable implant. Compared to a single-indication product, respondents had 2.46 times the odds (95% CI 1.04–2.68) of preferring a product also protecting against pregnancy, and 2.81 the odds (95% CI 1.04–3.05) of choosing a product that also protected against STIs. Adolescent girls and women in these countries showed strong preferences for longer-acting PrEP product formats, as well as those offering dual-protection. Introduction of long-acting options could improve PrEP uptake and reduce HIV burdens in east and southern African settings.

Preference for novel biomedical HIV pre-exposure prophylaxis methods among adolescent girls and young women in Kampala, Uganda: a mixed methods study

“…Previous studies among young people in Eastern and Southern Africa have also reported higher preference for long-acting PrEP methods ( 9 , 12 , 25 , 31 ). It is therefore not surprising that AGYW in the current study suggested that a longer acting pill and vaginal ring would be more appealing, as accessibility of methods and compliance make daily or frequently administered regimens challenging in this population of AGYW.…”

“…Another possible reason for the low uptake and adherence to oral PrEP among AGYW in Eastern and Southern Africa is that AGYW may have diverse preferences and needs regarding PrEP that are not sufficiently addressed by oral PrEP. Indeed, some studies from this region have indicated that young people may prefer PrEP products with longer duration of protection than oral PrEP ( 9–12 ) which also ensure high adherence. A previous study among AGYW in Kampala, Uganda, showed that a reported preference for oral PrEP over other PrEP methods was associated with higher oral PrEP uptake ( 5 ).…”

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

“…Study characteristics are summarised in Table 1. Most studies were crosssectional (22) including nine discrete choice experiments (DCEs). 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).…”

“…Since implants are already a common modality for extended-release contraceptives, a device which combines the two could be attractive to women seeking protection from both HIV and pregnancy. [7,15,17,[20][21][22][23][24].…”