Abstract
Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic especially in sub-Saharan Africa. Potent antiretroviral (ARV) drugs used as pre-exposure prophylaxis (PrEP) are currently being formulated as long-acting implantable devices, or nanosuspension injectables that release drug at a sustained rate providing protection from acquiring HIV. PrEP as implants (PrEP Implants) offers an innovative and novel approach, expanding the HIV prevention toolbox. Feedback from providers and future users in the early clinical product development stages may identify modifiable characteristics which can improve acceptability and uptake of new technologies. Healthcare workers (HCWs) perspectives and lessons learned during the rollout of contraceptive implants will allow us to understand what factors may impact the roll-out of PrEP implants. We conducted eighteen interviews with HCWs (9 Nurses and 9 Community Healthcare Workers) in rural KwaZulu-Natal, South Africa. HCWs listed the long-acting nature of the contraceptive implant as a key benefit, helping to overcome healthcare system barriers like heavy workloads and understaffing. However, challenges like side effects, migration of the implant, stakeholder buy-in and inconsistent training on insertion and removal hampered the roll-out of the contraceptive implant. For PrEP implants, HCWs preferred long-acting products that were palpable and biodegradable. Our findings highlighted that the characteristics of PrEP implants that are perceived to be beneficial by HCWs may not align with that of potential users, potentially impacting the acceptability and uptake of PrEP implants. Further our data highlight the need for sustained and multi-pronged approaches to training HCWs and introducing new health technologies into communities. Finding a balance between the needs of HCWs that accommodate their heavy workloads, limited resources at points of delivery of care and the needs and preferences of potential users need to be carefully considered in the development of PrEP implants.
Highlights
Preventing new HIV infections remains a global challenge and a major barrier to achieving the United Nations 2030 goal of ending AIDS as a public health threat
All the participants were female (Note that in this study, women are defined as cis-gender women, i.e. individuals assigned female sex at birth and that identify their gender as a woman).The mean age of the primary health care clinics (PHCs) nurses was 41 years, and 41 years for CHWs
The analysis identified four major themes, 1) Benefits and challenges associated with contraceptive implants, 2) Important characteristics for an HIV prevention implant, 3) Capacity development and training of service providers, and 4) Engaging the local community on new technologies (Table 2)
Summary
Preventing new HIV infections remains a global challenge and a major barrier to achieving the United Nations 2030 goal of ending AIDS as a public health threat Recent developments such as oral pre-exposure (PrEP) and the vaginal ring provide options that, for the first time, offer a cis-gender women-initiated HIV prevention method [1,2,3,4]. While these provide valuable protection against HIV infection, some young women aged 15–24 years old in sub-Saharan Africa (where 25% of global new infections occur) face challenges with adherence [5]. An implant containing tenofovir alafenamide (TAF) for PrEP HIV prevention is currently in the early stages of clinical development [16]
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