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.
Highlights
Preventing HIV and unintended pregnancy are health priorities for women globally
The multipurpose prevention technology (MPT) tablets were represented by placebo TDF/FTC with a daily dosing requirement; the MPT injections were represented by two 2 mL saline injections, one in each gluteal muscle, given at the same time once per month; and the MPT vaginal ring was represented by the silicone elastomer placebo vaginal ring developed by the International Partnership for Microbicides, which was to be used in the vagina continuously for one month
To inform future MPT product development, we aimed to examine the research questions in two diverse geographic areas within sub-Saharan Africa to evaluate the consistency of findings
Summary
Preventing HIV and unintended pregnancy are health priorities for women globally. In sub-Saharan Africa, nearly one in four married or in-union women are estimated to have an unmet need for contraception, with use of modern contraceptives varying across geographic settings and population groups [1]. In many sub-Saharan African countries with persistent unmet need for contraceptives, women are at high risk of HIV infection [4]. MPTs that combine HIV prevention and contraceptives in one delivery form offer a strategy to ease user and health systems burden as well as address key barriers to adoption of either biomedical prevention method alone [5, 6]. MPTs may increase adherence by simplifying use and capitalizing on the opportunity to integrate HIV prevention with a less stigmatized indication, pregnancy prevention
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