Abstract
BackgroundFor the first time in the history of HIV, new bio-medical interventions have been shown to be effective in preventing HIV transmission. For these new HIV prevention technologies (NPTs) to have an impact on the epidemic, they must be widely used. This study uses a discrete choice experiment (DCE) to: understand the relative strength of women’s preferences for product characteristics, understand the implications for substitution away from male condoms, and inform realistic modelling of their potential impact and cost-effectiveness.MethodsA DCE was conducted among 1017 women in urban South Africa. Women were presented with choices between potential women’s NPTs (microbicides, diaphragm, female condom) and ‘what I did last time’ (use or not use a condom) with different HIV and pregnancy prevention effectiveness’ and prices. Choice probabilities are estimated using the nested logit model and used to predict uptake.ResultsIn this high HIV prevalence setting, HIV prevention effectiveness is the main driver of uptake followed by pregnancy prevention effectiveness. For example a microbicide with poor effectiveness would have niche appeal at just 11% predicted uptake, while a highly effective microbicide (95% effective against HIV and pregnancy) would have far wider appeal (56% predicted uptake). Though women who reported not using condoms were more likely to choose the NPTs, at current very high rates of male condom use in South Africa (60%), about half of microbicide uptake is projected to be among those currently not using condoms.ConclusionsWomen are very interested in NPTs, especially if highly effective in preventing HIV and pregnancy. Women in greatest need were also most likely to switch to the new products. Where products are not yet available for distribution, proxy data, such as that generated by DCEs, can bring realism to overly optimistic uptake scenarios found in many current impact models.
Highlights
For the first time in the 30 year history of HIV, new bio-medical interventions have been shown to be effective in preventing HIV transmission [1]
This discrete choice experiment (DCE) aims to identify the key attributes of new HIV prevention technologies (NPTs), microbicides, the diaphragm, and the female condom, that drive women’s willingness and ability to use them within the context of their own intimate lives
More than a third were employed and just under a third lived in a household that had a working car. This is close to the national averages among adult urban women in South Africa
Summary
For the first time in the 30 year history of HIV, new bio-medical interventions have been shown to be effective in preventing HIV transmission [1]. In the light of these new HIV prevention technologies (NPTs), there has been much speculation and debate about the potential for ‘risk compensation’ following the introduction of a partially effective NPT [7]. For the first time in the history of HIV, new bio-medical interventions have been shown to be effective in preventing HIV transmission For these new HIV prevention technologies (NPTs) to have an impact on the epidemic, they must be widely used. This study uses a discrete choice experiment (DCE) to: understand the relative strength of women’s preferences for product characteristics, understand the implications for substitution away from male condoms, and inform realistic modelling of their potential impact and cost-effectiveness
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