Evaluation of a behavior-centered design strategy for creating demand for oral PrEP among young women in Cape Town, South Africa.

Jennifer F Morton,Katherine Gill,Katherine K Thomas,Ariane Van Der Straten,Connie Celum,Linda-Gail Bekker,Margaret Mcconnell,Valerie Curtis,Laura Myers,Robert Aunger,Menna Duyver,Gabrielle Stein,Lut Van Damme,Jared M Baeten,Jessie De Witt Huberts

doi:10.12688/gatesopenres.13103.2

Abstract

There is an urgent need to find effective interventions that reduce young South African women's vulnerability to HIV, and pre-exposure prophylaxis (PrEP) is highly effective when taken consistently. As national programs in Africa launch PrEP programs for young women, it is critical to understand how to effectively create awareness, stimulate interest, and increase uptake of PrEP. Behavior-centered design (BCD) guided the development of a PrEP social marketing campaign for young women. Ethnographic observations, in-depth interviews, and focus-group discussions with young South African women informed the content and design of a 90-second PrEP demand creation video and two informational brochures. A short survey was administered to young women at their homes after watching a video to evaluate PrEP interest. Of 800 households with a 16-25-year-old female identified from a Cape Town township census, 320 women in these households viewed the video and completed a survey about the video and their interest in PrEP. In focus groups, young women from the township preferred local characters and messaging that was empowering, simple, and motivational. From the household survey of young women who viewed the video, most reported interest in learning more about PrEP (67.7% 'definitely interested' and 9.4% 'somewhat interested') and taking PrEP (56.4% 'definitely interested' and 12.5% 'somewhat interested'). Factors significantly associated with interest in taking PrEP were having a primary partner with whom they regularly have sex (80.0% vs. 65.2% without a primary partner; adjusted odds ratio (AOR)=3.1, 95% CI: 1.3, 7.0) and being in a sexual partnership for <6 months (86.8% vs. 68.5% for >12 months; AOR=3.0, 95% CI: 1.2, 7.3). A positively framed PrEP demand creation video generated high interest in PrEP among young South African women, particularly among women with a primary partner and a shorter-term relationship. Registration: NCT03142256; registered on 5 May 2017.

Highlights

There is an urgent need to find effective interventions that reduce young South African women’s vulnerability to HIV, and pre-exposure prophylaxis (PrEP) is highly effective when taken consistently
Phase I (Assess): Gather existing knowledge and develop a working hypothesis The first step of the Behavior-centered design (BCD) process involves assessing what is known about the target audience (South African AGYW), the behavior of interest (PrEP uptake and adherence), and the parameters of the intervention in order to establish a hypothesis about how behavior change may be achieved
Findings suggested that a successful demand creation strategy could harness young women’s desire to increase their attractiveness to partners, increase emotional intimacy, avoid the social consequences of HIV, and become role models through becoming early adopters of PrEP

Summary

Introduction

There is an urgent need to find effective interventions that reduce young South African women’s vulnerability to HIV, and pre-exposure prophylaxis (PrEP) is highly effective when taken consistently. Methods: Behavior-centered design (BCD) guided the development of a PrEP social marketing campaign for young women. Ethnographic observations, in-depth interviews, and focus-group discussions with young South African women informed the content and design of a 90-second PrEP demand creation video and two informational brochures. A short survey was administered to young women at their homes after watching a video to evaluate PrEP interest. Results: In focus groups, young women from the township preferred local characters and messaging that was empowering, simple, and motivational. From the household survey of young women who viewed the video, most reported interest in learning more about PrEP (67.7% ‘definitely interested’ and 9.4% ‘somewhat interested’) and taking PrEP (56.4% ‘definitely version 2 (revision)

Methods

Results

Conclusion