Willingness to use HIV prevention methods among vaccine efficacy trial participants in Soweto, South Africa: discretion is important

Abstract

Background Despite multiple available HIV prevention methods, the HIV epidemic continues to affect South Africa the most. We sought to understand willingness to use actual and hypothetical HIV prevention methods among participants enrolled in a preventative HIV vaccine efficacy trial in Soweto, South Africa. Methods We conducted a qualitative study with 38 self-reporting HIV-uninfected and consenting 18–35 year olds participating in the HVTN 702 vaccine efficacy trial in Soweto. Using a semi-structured interview guide, five focus group discussions (FGDs) were held, stratified by age, gender and sexual orientation. The FGDs were composed of: (i) 10 heterosexual women aged 18–24 years; (ii) 9 heterosexual and bisexual women aged 25–35 years; (iii & iv) heterosexual men aged 25–35 years with 7 in both groups; and (v) 5 men aged 18–35 years who have sex with men. FGDs were audio-recorded, transcribed verbatim, translated into English and analysed using thematic analysis. Results We present five main themes: (i) long-lasting methods are preferable; (ii) condoms are well-known but not preferred for use; (iii) administration route of HIV prevention method is a consideration for the user; (iv) ideal HIV prevention methods should blend into the lifestyle of the user; and the perception that (v) visible prevention methods indicate sexual indiscretion. Conclusions The participants’ candour about barriers to condom and daily oral pre-exposure prophylaxis (PrEP) use, and expressed preferences for long-lasting, discreet, lifestyle-friendly methods reveal a gap in the biomedical prevention market aiming to reduce sexually acquired HIV in South Africa. Product developers should consider long-acting injectable formulations, such as vaccines, passive antibodies and chemoprophylaxis, for HIV prevention technologies. Future innovations in HIV prevention products may need to address the desire for the method to blend easily into lifestyles, such as food-medication formulations.

Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial

“…Studies show that many women in sub-Saharan Africa would prefer a long-acting injectable agent for PrEP. 25 , 26 , 27 This might in part reflect the widespread use of and familiarity with injectable contraception. The protective benefit of cabotegravir was consistent across age groups, including in those younger than 25 years.…”

A qualitative study to identify 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.

“…Current research is underway that tests the effectivenss of long-acting injectable formulations and intra-vaginal rings and potential alternatives to oral PrEP [52]. Further evaluations are required that focus on the willingness and perceptions of alternative application methods of PrEP amongst young people and not just for adults [53].…”

Prospective study of oral pre‐exposure prophylaxis initiation and adherence among young women in KwaZulu‐Natal, South Africa

“…Safety and efficacy of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as oral PrEP has been demonstrated in several studies [8][9][10], with most evidence indicating that oral PrEP works best in men who have sex with men in high-income settings, and this may be related to biopsychosocial reasons [11]. For young women, oral PrEP may offer additional benefits as it can be initiated without the knowledge or consent of the partner; however, in some instances, taking a bottle of oral PrEP home may result in inadvertent disclosure to partners and/or families and could lead to mistrust, conflict and stigma [12]. Oral PrEP has been approved for use in SA and was initially rolled out by the National Department of Health to select sex worker sites in 2016 [13], but access has since expanded, and oral PrEP is currently available in several demonstration and implementation projects in SA [14].…”