Preferences for HIV pre-exposure prophylaxis formulations and delivery among young African women: results of a discrete choice experiment

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Wendy W. Dlamini, Brenda G. Mirembe, Meighan L. Krows, Sue Peacock, Philip L. Kotze, Pearl Selepe, Jenni Smit, Nelly Mandona, Cheryl Louw, Harriet Nuwagaba-Biribonwoha, Victor O. Omollo, Zinhle Zwane, Ravindre Panchia, Noluthando Mwelase, Melissa Senne, Logashvari Naidoo, Rachel Chihana, Sinead Delany-Moretlwe, Katherine Gill, Pippa MacDonald, Alastair van Heerden, Shannon Bosman, Remco P. H. Peters, Philip du Preez, Amy Ward, Connie Celum, Renee Heffron, Jennifer Velloza, for the INSIGHT Study Team
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引用次数: 0

Abstract

Introduction

Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, but adherence is challenging for young women. Products centred around women's preferences could address adherence barriers. Using a longitudinal discrete choice experiment (DCE), we examined young African women's preferences around PrEP product formulation and delivery attributes before and after initiating oral PrEP.

Methods

We enrolled HIV-negative women from six African countries in a prospective cohort from August 2022 to June 2023. Women completed two DCEs on PrEP products and PrEP delivery. At enrolment and month 1, participants completed the DCE about PrEP products with 16 randomly assorted choice sets assessing product form and dosing, dose forgiveness, drug reversibility, weight change and antiretroviral or immune-based mechanism attributes. At month 3, participants completed the DCE about PrEP delivery evaluating preferences related to location to collect doses, packaging, product storage, type of HIV test and costs. Preference weights (PW) were estimated with a hierarchical Bayesian model; higher positive numbers indicate greater preference for an attribute. Importance scores compare relative importance across the five attributes; higher scores indicate greater importance.

Results

Two thousand eight hundred and forty-seven women completed enrolment and month 1 DCEs; the median age was 24 years (range: 16–30) and 92.8% initiated daily oral PrEP. Product form and dosing was the most important attribute at enrolment and month 1. At enrolment, women preferred small oral pills taken monthly (preference weight [PW]: 0.67; 95% confidence interval [CI]: 0.58−0.77), and at month 1, they preferred a 6-monthly injection (PW: 0.56; 95% CI: 0.46−0.65). In the month 3 DCE, location was the most important PrEP delivery attribute with a strong preference for a youth-friendly or non-governmental organization (PW: 0.25; 95% CI: 0.19−0.30) or health facility (PW: 0.21; 95% CI: 0.17−0.25); mobile clinic or van was least preferred. The cost of the product was the second most important product delivery attribute.

Conclusions

Young African women preferred discreet, less frequently administered PrEP formulations, particularly after 1 month of taking daily oral PrEP. Long-acting formulations are needed to meet women's preferences. Coupled with the preferred PrEP delivery location and cost, the highlighted PrEP product characteristics have the potential to increase PrEP uptake.

Abstract Image

非洲年轻妇女对艾滋病毒暴露前预防配方和分娩的偏好:离散选择实验的结果
口服艾滋病毒暴露前预防(PrEP)非常有效,但对年轻女性来说,坚持治疗是一项挑战。以女性偏好为中心的产品可以解决依从性障碍。通过纵向离散选择实验(DCE),我们研究了年轻非洲女性在开始口服PrEP之前和之后对PrEP产品配方和递送属性的偏好。方法我们从2022年8月至2023年6月招募了来自6个非洲国家的hiv阴性妇女作为前瞻性队列。妇女完成了关于PrEP产品和PrEP交付的两次dce。在入组和第1个月,参与者完成了关于PrEP产品的DCE,有16个随机组合的选择集,评估产品的形式和剂量、剂量宽恕、药物可逆性、体重变化和抗逆转录病毒或免疫机制属性。在第3个月,参与者完成了关于PrEP递送的DCE,评估与收集剂量的地点、包装、产品储存、艾滋病毒检测类型和费用相关的偏好。采用层次贝叶斯模型估计偏好权重(PW);正数越大,表示对属性的偏好越大。重要性分数比较五个属性的相对重要性;分数越高表明重要性越大。结果2847名妇女完成了登记和第1个月的dce;中位年龄为24岁(范围:16-30岁),92.8%开始每日口服PrEP。产品形式和剂量是入组和第1个月时最重要的属性。在入组时,女性更喜欢每月服用口服小药片(偏好体重[PW]: 0.67;95%可信区间[CI]: 0.58−0.77),并且在第1个月时,他们更倾向于6个月的注射(PW: 0.56;95% ci: 0.46−0.65)。在第3个月,地点是最重要的PrEP交付属性,对青年友好组织或非政府组织有强烈的偏好(PW: 0.25;95% CI: 0.19 - 0.30)或卫生设施(PW: 0.21;95% ci: 0.17−0.25);移动诊所或面包车最不受欢迎。产品的成本是第二个最重要的产品交付属性。结论年轻的非洲妇女更喜欢谨慎的、较少使用的PrEP制剂,特别是在每天口服PrEP 1个月后。需要长效制剂来满足妇女的偏好。加上首选的PrEP交付地点和成本,突出的PrEP产品特性有可能增加PrEP的吸收。
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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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