Young Women’s Ratings of Three Placebo Multipurpose Prevention Technologies for HIV and Pregnancy Prevention in a Randomized, Cross-Over Study in Kenya and South Africa

Abstract

End-user input is critical to inform development of multipurpose prevention technology (MPT) products that prevent HIV and pregnancy. The TRIO Study, conducted in Kenya and South Africa, enrolled 277 HIV-negative women aged 18–30 in a randomized cross-over study to use each placebo MPT (daily oral tablets, monthly injections, and monthly vaginal ring) for one month. At the end of each month, participants rated how much they liked using the product on a 5-point Likert scale (5 = liked very much). We compared mean ratings using paired t-tests and examined sociodemographic-, attribute-, and behavior-related characteristics associated with ratings using multivariable linear regression and data from in-depth interviews. After use, mean ratings were significantly higher for injections [4.3 (SD = 1.0)] compared with tablets [3.0 (SD = 1.3)] and rings [3.3 (SD = 1.4)] (p < 0.001); mean ratings for rings were significantly higher than for tablets (p = 0.013). Mean ratings of a hypothetical active MPT increased for all products after the one-month period of use, with the greatest increase for rings, the least familiar product. In multivariable analysis, acceptability of key product attributes (e.g., product look) were associated with a significant increase of ≥ 1 point in the mean rating across all three products (p ≤ 0.001). Perceived ability to use the product without partner knowledge was associated with a higher mean rating for rings (b = 0.50; p = 0.006). The acceptability of product attributes contributed significantly to the rating of all products, highlighting the value of choice in pregnancy and HIV prevention to accommodate diverse users.

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

“…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 .…”

“…Differences in product choice across geographical settings have been identified in other studies. For example, in a companion study by our research group (“TRIO”), the majority of women in both Kenya and South Africa preferred injections overall, but the proportion of women in Kenya preferring oral tablets was significantly higher than in South Africa . The findings of both studies highlight the importance of conducting multisite research to assess the generalizability of findings across settings.…”

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

“…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.…”

Perspectives from Young South African and Zimbabwean Women on Attributes of Four (Placebo) Vaginal Microbicide Delivery Forms

“…When longer durations of use (1 year) were proposed for the ring, the proportion stating the duration would be acceptable decreased. While there is some evidence that longeracting HIV prevention products, such as injections, are more favored by end-users [28][29][30][31][32], longer may not translate into better for the ring, as women may not want to leave the ring inserted beyond 1 month due to hygiene or comfort concerns. This nuance warrants closer examination in future research to determine the optimal duration for different products, as well as counseling around hygiene, acceptable intermittent removals for menses and other concerns, given that longer-acting products are currently in development [33].…”