Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

Lancaster, Kathryn E.; Lungu, Thandie; Bula, Agatha; Shea, Jaclyn; Shoben, Abigail B.; Hosseinipour, Mina C.; Kohler, Racquel E.; Hoffman, Irving; Go, Vivian F.; Golin, Carol E.; Wheeler, Stephanie B.; Miller, William C.

doi:10.1007/s10461-019-02705-3

Cited by 25 publications

(27 citation statements)

References 42 publications

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“…The programme did not assess client preferences or perceived stigma associated with PrEP use. Studies in Kenya and Malawi showed that sex workers valued confidentiality, privacy, and trustworthiness [6] and preferred male providers and non‐stigmatizing locations for drug refills such as family planning clinics or NGO drop‐in centres [21]; suggesting a need to assess client preferences for PrEP refill locations.…”

Section: Discussionmentioning

confidence: 99%

Uptake and retention on HIV pre‐exposure prophylaxis among key and priority populations in South‐Central Uganda

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) programmes have been initiated in sub‐Saharan Africa to prevent HIV acquisition in key populations at increased risk. However, data on PrEP uptake and retention in high‐risk African communities are limited. We evaluated PrEP uptake and retention in HIV hyperendemic fishing villages and trading centres in south‐central Uganda between April 2018 and March 2019. Methods PrEP eligibility was assessed using a national risk screening tool. Programme data were used to evaluate uptake and retention over 12 months. Multivariable modified Poisson regression estimated adjusted prevalence ratios (aPR) and 95% Confidence intervals (CIs) of uptake associated with covariates. We used Kaplan–Meier analysis to estimate retention and multivariable Cox regression to estimate adjusted relative hazards (aRH) and 95% CIs of discontinuation associated with covariates. Results and discussion Of the 2985 HIV‐negative individuals screened; 2750 (92.1 %) were eligible; of whom 2,536 (92.2%) accepted PrEP. Male (aPR = 0.91, 95% CI = 0.85 to 0.97) and female (aPR = 0.85, 95% CI = 0.77 to 0.94) fisher folk were less likely to accept compared to HIV‐discordant couples. Median retention was 45.4 days for both men and women, whereas retention was higher among women (log rank, p < 0.001) overall. PrEP discontinuation was higher among female sex workers (aRH = 1.42, 95% CI = 1.09 to 1.83) and female fisher folk (aRH = 1.99, 95% CI = 1.46 to 2.72), compared to women in discordant couples. Male fisher folk (aRH = 1.37, 95% CI = 1.07 to 1.76) and male truck drivers (aRH = 1.49, 95% CI = 1.14 to 1.94) were more likely to discontinue compared to men in discordant couples. Women 30 to 34 years tended to have lower discontinuation rates compared to adolescents 15 to 19 years (RH = 0.78 [95% CI = 0.63 to 0.96]). Conclusions PrEP uptake was high, but retention was very low especially among those at the highest risk of HIV: fisher folk, sex workers and truck drivers and adolescent girls. Research on reasons for PrEP discontinuation could help optimize retention.

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Section: Discussionmentioning

confidence: 99%

Uptake and retention on HIV pre‐exposure prophylaxis among key and priority populations in South‐Central Uganda

et al. 2020

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“…Three (11%) reported relative impor-tance scores [32,40,41]. Several studies also conducted mixed-logit (8, 29%) [33,34,[42][43][44][45][46][47], nested-logit (3, 11%) [35,36,48], or random parameters logit (7, 25%) [32,35,[49][50][51][52][53] (some studies reported more than one model). Most of the DCE studies (24/28, 86%) further measured preference heterogeneity using stratification/subgroup analyses and/or interaction terms (17, 61%), or latent class analysis (6, 21%) [29,33,40,46,51,52].…”

Section: Dcementioning

confidence: 99%

“…The most common PrEP product design attributes were frequency of dosing (daily, monthly) and product formulation, which necessarily overlap (pills: daily; injections: monthly). Some studies found that dosing frequency was unimportant compared to other attributes [43,61,79], while other studies showed preferences for daily pills [33,40,65,71], for monthly or bimonthly injections or implants [51,70,91], or for on-demand dosing (with sexual encounters) of rectal gels [64,79]. Formulation (pills, injections, rings, gel) was found to be variously as important as efficacy [29], even more important than efficacy [64], or secondary to efficacy [91].…”

Section: Product Designmentioning

confidence: 99%

“…In subgroup analyses of MSM in the USA, cost was important in every group, while the importance of other attributes varied [40]. For dispensing sites, FSW in Malawi most valued family planning clinics or drop-in centers [43], FSW near the US-Mexico border preferred healthcare clinics vs nongovernmental organizations [64], MSM in Thailand and the USA preferred pharmacies [40,71], and people who used drugs in the USA preferred HIV clinics over drug treatment clinics [65]. Dispensing site was the most important attribute in African countries in a multinational study; dispensing at HIV treatment clinics was highly devalued; the authors hypothesize this was related to HIV stigma [70].…”

Section: Service Designmentioning

confidence: 99%

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Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Beckham

Crossnohere

Gross

et al. 2020

Patient

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Background Many human immunodeficiency virus (HIV) prevention technologies (pre-exposure prophylaxis, microbicides, vaccines) are available or in development. Preference elicitation methods provide insight into client preferences that may be used to optimize products and services. Given increased utilization of such methods in HIV prevention, this article identifies and reviews these methods and synthesizes their application to HIV prevention technologies. Methods In May 2020, we systematically searched peer-reviewed literature in PubMed, CINAHL, and Web of Science for studies employing quantitative preference elicitation methods to measure preferences for HIV prevention technologies among populations of any age, sex, or location. Quality assessment used an existing checklist (PREFS) and a novel adaptation of the Newcastle–Ottawa Scale (PROSPERO #CRD42018087027). Results We screened 5022 titles and abstracts, reviewed 318 full texts, and included 84 studies. Common methods employed were discrete-choice experiment (33%), conjoint analysis (25%), and willingness-to-participate/try/accept (21%). Studies were conducted in 25 countries and had a mean of 768 participants (range = 26–7176), two-thirds of them male. Common HIV prevention technologies included pre-exposure prophylaxis (23%), voluntary testing and counseling (19%), HIV self-testing (17%), vaccines (15%), and topical microbicides (9%). Most attributes focused on product design (side effects, frequency), service design (provider type, location), acceptability or willingness to accept/pay; results are summarized in these categories, by prevention type. Mean quality-adapted Newcastle–Ottawa Scale score was 4.5/8 (standard deviation = 2.1) and mean PREFS scores was 3.47/5 (standard deviation = 0.81). Conclusions This review synthesizes extant literature on quantitative measurement of preferences for HIV prevention technologies. This can enable practitioners to improve prevention products and interventions, and ultimately reduce HIV incidence.

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“…Using daily PrEP would ensure protection for spontaneous or unanticipated sexual activities. Young people are often less likely to anticipate sex, which also includes communication and control within relationships [25]. This may be particularly true for young women, as they often have less decision making power and be less likely able to negotiate when sex occurs [44].…”

Section: Discussionmentioning

confidence: 99%

Identifying 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.

Dietrich

Atujuna

Tshabalala

et al. 2020

Preprint

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Background Oral Pre-Exposure Prophylaxis (PrEP) was approved for use in South Africa (SA) in 2017. The uptake and adherence of daily oral PrEP has been poor in high-risk populations in SA including adults and young people. We used a Discrete Choice Experiment (DCE) technique to identify critical attributes and attribute-levels to understand user preferences for daily and on-demand oral PrEP use among young people, including adolescents, in two South African cities. Methods Qualitative data were collected between September and November 2018 from 8 group discussions and 20 in-depth interviews with young people aged 13 to 24 years in Cape Town and Johannesburg. Participants were selected based on stratified (gender and age) purposive sampling. Using a semi-structured interview guide, interviewers discussed several attributes (dosing regimen, location, costs, side effects, and protection period) for PrEP access and use. Transcripts were coded to identify context-specific attributes and attribute-levels for delivering oral PrEP in South Africa. The adolescent community advisory board, expert and study team opinions were consulted for the final DCE attributes and levels. Results We enrolled 74 participants: 51% (n=38/74) male, median age of 18.5 [IQR=16-21.25] years, 91% (n=67/74) identified as heterosexual and 49% (n=36/74) had not completed 12th grade education. Using the qualitative data, we identified five candidate attributes including (1) dosing regimen, (2) location to get PrEP, (3) cost, (4) route of administration and (5) frequency. After discussions with experts and the study team, we revised the DCE to include the following five attributes and levels: dosing regime: daily, and on-demand PrEP; location: private pharmacy, public clinic, mobile clinic, ATM); cost: free-of-charge, R50 (~2GBP), R265 (~12GBP); side effects: nausea, headache, rash; and duration of protection: fulltime protection versus when PrEP is used). Conclusions There is limited methodological literature describing the step-by-step process of developing a DCE for PrEP in adolescents, especially in resource-constrained countries. We provide the process followed for the DCE technique to understand user preferences for daily and on-demand oral PrEP among young people in South Africa.

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Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

Cited by 25 publications

References 42 publications

Uptake and retention on HIV pre‐exposure prophylaxis among key and priority populations in South‐Central Uganda

Uptake and retention on HIV pre‐exposure prophylaxis among key and priority populations in South‐Central Uganda

Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Identifying 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.

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