Prospective acceptability of a multipurpose technology (MPT) implant in preclinical development to prevent HIV and unplanned pregnancy: Qualitative insights from women end users and health care providers in South Africa and Zimbabwe

Abstract

Background Given the high rates of both HIV and unintended pregnancies in sub-Saharan Africa, the SCHIELD program aims to develop a multipurpose technology implant for HIV and pregnancy prevention. An end-user evaluation was undertaken with young women and health care providers to assess preferences for modifiable implant attributes to improve future adoption and rollout. Methods Focus group discussions were conducted with potential women end users, and health care providers experienced in implant insertion or removal participated in in-depth interviews. All participants were recruited from Harare, Zimbabwe, or Soshanguve, South Africa. The purposively stratified sampled women were either implant experienced or implant naïve and were categorized into three groups: nulliparous, postpartum, or engaged in transactional sex. Topics covered included duration (six months to three years), biodegradability, removability, and independent rod retrievability (per indication). Data were analyzed using Dedoose software and summarized into emerging themes. Results Participants identified three key areas that could facilitate rollout, uptake, and adherence of an implant for HIV and pregnancy prevention. First, discreetness was the most salient topic and was associated with implant characteristics such as anatomical location, flexibility, and biodegradability. Second, the ability to independently retrieve the HIV or pregnancy prevention component was preferred, as life circumstances may change and was favored by all participants, except for young women in Soshanguve. Third, there is a need for proper counseling, sensitization, provider training, and health campaigns to facilitate rollout of a 2-in-1 implant. Conclusions A 2-in-1 implant was seen as highly desirable by most young women and health care providers. Participants discussed potential concerns and barriers to uptake of a biodegradable implant with dual HIV prevention and contraceptive properties, identifying key implant attributes that product developers can modify while still in preclinical stages.

Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: a scoping review

“…Participants also viewed MPTs as a product for improved sexual and reproductive health protection and reported that an MPT's overall purpose was more important than product-specific attributes ( 20 , 23 , 31 , 34 , 40 , 46 , 47 , 52 ). Few studies reported reasons for not preferring MPTs; however, those that did noted the primary reason was a desire to conceive, retaining the option for flexibility, or concerns with drug toxicity ( 42 , 45 , 47 , 52 ).…”

“…Known and used delivery forms such as injectables and tablets were initially preferred and ranked higher than newer delivery forms such as the ring and implant ( 6 , 18 , 38 , 40 , 43 , 44 , 47 , 50 , 51 ). Reasons for preferring familiar products included decreased hesitation about side effects due to the ability to stop product use quickly, confidence in how to use the product discreetly, and ease of explanation to partners, family, peers, and community members ( 6 , 18 , 25 , 38 , 45 , 50 ). However, initial concerns about unfamiliar products and unfamiliar product attributes could be overcome through learning about products and using products.…”

“…In one study, end users initially expressed concerns about partner detection of product use but later reported that this happened infrequently ( 38 ). Importantly, the physical delivery form of a product played a role in what discreet use could or might look like, with specific discretion-related considerations for each product; for example, physical location on the body and palpability of an implant ( 45 ). In a DCE with end users in South Africa, the importance of being able to use a product discreetly was rated with greater importance among end users who reported ever having difficulties negotiating condom use compared to those without condom negotiation difficulties ( 49 ).…”

“…The available data indicated that although some end users had concerns about side effects of potential active MPTs, most end users discussed pain and discomfort with product administration more frequently and saliently than drug-related side effects. For example, end users discussed fear of painful MPT placement or administration within research about injectables, implants, and rings ( 6 , 30 , 43 , 45 ).…”

“…Effects of MPT use on fertility and product-related preferences to facilitate return to fertility were explored infrequently in the reviewed articles. This topic was largely examined within studies on nanofiber fabric and implants and constituted one of the attributes included in MTN 045/CUPID, which included vaginal film/inserts, vaginal ring, and oral tablets ( 24 , 29 , 31 , 42 , 45 ). Some end users expressed preferences for MPT products that allowed for flexibility in contraception administration or similarly noted that lack of flexibility in contraception coverage was a limitation of specific methods ( 31 , 45 ).…”