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

Abstract

IntroductionWomen in sub-Saharan Africa (SSA) experience disproportionately high rates of HIV infection and unintended pregnancy compared to their age-matched counterparts in other regions of the world. Multipurpose prevention technologies (MPTs) that offer protection against HIV and unintended pregnancy in a single product stand to address these dual sexual and reproductive health needs simultaneously. The aim of this scoping review is to identify factors that are important for optimizing the likelihood of MPT adoption by end users in SSA.MethodsStudy inclusion criteria included MPT research (HIV and pregnancy prevention dual indication) published or presented in English from 2000 to 2022 and conducted in SSA amongst end-users (women aged 15–44), male partners, health care providers, and community stakeholders. References were identified by searching peer reviewed literature, grey literature, conference presentations (2015–2022), grant databases, and outreach to MPT subject matter experts. Of 115 references identified, 37 references met inclusion criteria and were extracted for analysis. A narrative synthesis approach was used to summarize findings within and across MPT products.ResultsStudies were identified from six countries in SSA and a substantial proportion included a South African (n = 27) and/or Kenyan (n = 16) study site. Most studies utilized a qualitative study design (n = 22) and evaluated MPT acceptability and preferences by presenting hypothetical products through images or a list of product attributes (n = 21). The vaginal ring (n = 20), oral tablet (n = 20), and injection (n = 15) were examined most frequently. Across studies, there was high acceptability and demand for an HIV and pregnancy prevention MPT. End users valued choice in prevention product type as well as discreetness and long-acting options. Provider counseling and community sensitization were reported as essential for future introduction of novel MPT delivery forms.ConclusionRecognizing the heterogeneity of women's preferences and changing reproductive and sexual health needs over the life course, choice is important in the delivery of pregnancy and HIV prevention products as well as amongst MPT products with distinct product profiles. End user research with active MPTs, vs. hypothetical or placebo MPTs, is necessary to advance understanding of end-user preferences and acceptability of future products.

Prevention method preferences and factors influencing hypothetical choice among women in South Africa: a survey exploring opportunities for a multipurpose prevention technology implant

“…MPTs present an opportunity to address multiple prevention needs among women. The results from this study are consistent with others, which provide a strong indication that women want to prevent pregnancy, HIV and STIs, and would prefer an MPT over single-purpose products ( 17 , 18 , 27 , 29 – 33 ). The prevention methods most preferred by women in this study were a 6-monthly sub-cutaneous injection, followed by a monthly pill and a 2-year biodegradable implant, with half of women choosing any MPT-implant method and a quarter each choosing a pill or an injectable method.…”

“…Our findings support others which suggest that prior use of a method type may increase its acceptability and use ( 33 ). The TRIO study, a randomised cross over study of placebo MPTs found that prior use of a product was associated with a preference for that product at baseline ( 41 ) and that product ratings increased with use, indicating that the experience of using a product may increase its acceptability ( 16 ).…”

Reversible female contraceptives: historical, current, and future perspectives

“…Moreover, the delivery method for MPT is versatile. MPTs have been formulated into vaginal administrations (ring, diaphragm, gel, film), oral administration (such as DPP), injectable, implant, and microarray patch [230]. Action strategies were put forward by the reproductive experts emphasizing the importance of MPTs, which will “ address multiple reproductive health needs with a single product ” [231].…”

Perception of couples’ on multipurpose prevention technology attribute choice: the case of MTN 045

“…To address these challenges, multipurpose prevention technologies (MPTs), also known as “combination” or “dual” technologies, have been developed to simultaneously address multiple sexual and reproductive health needs, including unintended pregnancy and STIs, including HIV [ 11 ]. Results of previous studies have shown that women may find a product that prevents HIV and pregnancy more acceptable and likely to be used [ 15 ]. However, the influence of existing perceptions regarding HIV and pregnancy prevention methods on the acceptability and use of MPTs in Eastern and Southern Africa remains poorly understood.…”