Stated product formulation preferences for HIV pre‐exposure prophylaxis among women in the VOICE‐D (MTN‐003D) study

Abstract

IntroductionThe effectiveness of HIV pre-exposure prophylaxis (PrEP) requires consistent and correct product use, thus a deeper understanding of women's stated product formulation preferences, and the correlates of those preferences, can help guide future research. VOICE-D (MTN-003D), a qualitative ancillary study conducted after the VOICE trial, retrospectively explored participants’ tablet and gel use, as well as their preferences for other potential PrEP product formulations.MethodsWe conducted an analysis of quantitative and qualitative data from VOICE-D participants. During in-depth interviews, women were presented with pictures and descriptions of eight potential PrEP product formulations, including the oral tablet and vaginal gel tested in VOICE, and asked to discuss which product formulations they would prefer to use and why. Seven of the original product formulations displayed were combined into preferred product formulation categories based on exploratory factor and latent class analyses. We examined demographic and behavioural correlates of these preferred product formulation categories. In-depth interviews with participants were conducted, coded, and analysed for themes related to product preference.ResultsOf the 68 female participants who completed in-depth interviews (22 South Africa, 24 Zimbabwe, 22 Uganda), median age was 28 (range 21–41), 81% were HIV negative, and 49% were married or living with a partner. Four preferred product formulation categories were identified via exploratory factor analysis: 1) oral tablets; 2) vaginal gel; 3) injectable, implant, or vaginal ring; and 4) vaginal film or suppository. A majority of women (81%) expressed a preference for product formulations included in category 3. Characteristics significantly associated with each preferred product category differed. Attributes described by participants as being important in a preferred product formulation included duration of activity, ease of use, route of administration, clinic- versus self-administration, and degree of familiarity with product.ConclusionsWhile there was interest in a variety of potential PrEP product formulations, a majority of VOICE-D participants preferred long-acting methods. More research is needed to gain insight into end-users’ product formulation preference to inform messaging and market segmentation for different PrEP products and resources to invest in products that target populations are most interested in using.Clinical Trial Number: NCT02358616

End‐user preference for and choice of four vaginally deliveredHIVprevention methods among young women in South Africa and Zimbabwe: the Quatro Clinical Crossover Study

“…Similar results were reported among adolescent users of the contraceptive NuvaRing in the United States . Other studies in Africa have likewise identified that familiarity with a delivery method is correlated to preference . Product developers and researchers should therefore be mindful that introduction of a novel method may face initial resistance, but these opinions may be amenable to change through provision of information, support and practice in use of the method through introductory use periods.…”

“…The findings of both studies highlight the importance of conducting multisite research to assess the generalizability of findings across settings. Furthermore, the fact that there were country differences, and that the distribution of products chosen and ranked number one was fairly evenly distributed support the findings of other research studies and the call for continued research and development of a range of options for women, a priority that has been threatened by funding cuts, fears of expensive registration trials, and false assumptions about what methods women will use . The contraceptive field can offer important parallels: as the method mix for modern contraception has increased in Sub‐Saharan Africa, so has the overall proportion of users .…”

HIV pre‐exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

“…Acceptability research conducted since VOICE and FEM‐PrEP indicate that women desire low burden prevention strategies that are compatible with their lifestyles and provide peace of mind . Indeed, a daily pill regimen can be both logistically and emotionally burdensome (as it may remind women about HIV or IPV) .…”

“…Indeed, a daily pill regimen can be both logistically and emotionally burdensome (as it may remind women about HIV or IPV) . When offered HIV prevention alternatives through discrete choice experiments which assess hypothetical preferences and trade‐offs between them, women prefer longer‐acting and more adherence “forgiving” products, supporting the development of a range of PrEP delivery modalities – ring, injectable, implantable – from which young women can choose . In parallel with development of formulations with less frequent dosing, it is important to learn about delivery and use of oral PrEP, a vanguard product.…”

Achieving the Optimal Vaginal State: Using Vaginal Products and Study Gels in Uganda, Zimbabwe, and South Africa

“…Yet, findings from our research published in an earlier paper showed that amongst a range of eight modes of delivery for biomedical HIV prevention products (cervical barrier, implants, injectables, oral tablets, vaginal gel, vaginal film, vaginal ring, and vaginal suppository), gels did not rank highly in product preference ratings (Luecke et al, 2016). Women perceived gels to create uncomfortable sensations of being wet and leaky.…”