Abstract
PurposeUnintended pregnancy and HIV infection present dual risks for young women in sub-Saharan Africa. New multipurpose prevention technologies (MPTs) are in development to simultaneously prevent unintended pregnancy and HIV, but there is a need for end-user research to ensure these products suit women’s needs. The Tablet, Rings and Injectables as Options (TRIO) for women study took place in Kisumu, Kenya, and Soshanguve, South Africa, with the goal of eliciting young women’s feedback on three potential MPTs.MethodsWomen in TRIO used three placebo products that represented potential MPTs: daily oral tablets, monthly vaginal rings, and monthly dual injections in a randomized crossover design followed by a period in which they chose a product to use. Eighty-eight TRIO participants completed in-depth interviews and focus group discussions to understand their experiences using each product. Qualitative analyses were conducted after stratifying by product preference at the end of the crossover period.ResultsThe majority (65%) of participants preferred injections, with the remainder evenly split between tablets and rings. Discussions of preference for one product were closely linked with expressed dislike of another product’s attributes. Participants recognized heterogeneity in preferences and choices across users and stressed the need for multiple MPT options that confer a low burden on women’s daily lives.ConclusionRather than choosing a product to use based on the product’s perceived advantages, women’s choices were based on the unfavorable attributes of other TRIO products. Moreover, the importance that women placed on a given disadvantage varied. Disadvantages that women deemed as most important emerged as a greater driver of product preference than selecting products based on their advantages and favorable characteristics.
Highlights
Unintended pregnancy and HIV infection constitute two challenges to achieving the United Nations 2030 Agenda for Sustainable Development in adolescent girls and young women
Participants who were exiting the study at similar times and who had chosen the same product were invited to a focus group discussion (FGD) to discuss how their experience with and preferences between products may have been the same or different – one FGD per product was conducted at each site (N=6)
Among the 88 women who participated in the qualitative component of the TRIO study, 45 were from Kisumu, Kenya, 43 from Soshanguve, South Africa, and the median age for the sample was 23 years
Summary
Unintended pregnancy and HIV infection constitute two challenges to achieving the United Nations 2030 Agenda for Sustainable Development in adolescent girls and young women. Multiple MPTs are being developed, including injectables, vaginal rings, gels, films, and inserts.[4] Whereas developers of biomedical products are required to demonstrate safety and efficacy, experience in the field of reproductive health has shown that end-users must be willing and able to use them for these technologies to achieve real-world effectiveness.[5,6,7] it is essential to ensure that the voices of the intended users – in this case, women in sub-Saharan Africa – are heard and responded to in the development of these products. Researchers in the MPT field have noted the need to incorporate end-user perspectives to assess the preference and inform the product development process, marketing, and roll out.[8,9,10] past research for HIV prevention and contraception has gained valuable insights when input from study participants was elicited.[11,12,13]
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