Efficacy is Not Everything: Eliciting Women’s Preferences for a Vaginal HIV Prevention Product Using a Discrete-Choice Experiment

Browne, Erica N.; Montgomery, Elizabeth T.; Mansfield, Carol; Boeri, Marco; Mange, Brennan; Beksinska, Mags; Schwartz, Jill L.; Clark, Meredith R.; Doncel, Gustavo F.; Smit, Jenni; Chirenje, Zvavahera M.; Straten, Ariane van der

doi:10.1007/s10461-019-02715-1

Cited by 29 publications

(24 citation statements)

References 31 publications

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“…Nineteen studies examined PrEP [ 33 , 34 , 36 , 40 , 43 , 46 , 49 , 51 , 61 , 64 – 66 , 70 , 71 , 78 , 79 , 83 , 90 , 91 , 101 ].…”

Section: Resultsmentioning

confidence: 99%

“…In studies that considered the vaginal ring, the ring rated poorly compared with other formulations, and was sometimes the least preferred [ 33 , 34 , 51 , 64 , 83 ]. Other product attributes included side effects, efficacy, additional protection from pregnancy or STI (pregnancy prevention was valued; STI prevention was valued among female sex workers [FSW]) [ 46 , 49 , 83 ]; and changes to menstruation [ 51 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three (11%) reported relative impor-tance scores [32,40,41]. Several studies also conducted mixed-logit (8, 29%) [33,34,[42][43][44][45][46][47], nested-logit (3, 11%) [35,36,48], or random parameters logit (7, 25%) [32,35,[49][50][51][52][53] (some studies reported more than one model). Most of the DCE studies (24/28, 86%) further measured preference heterogeneity using stratification/subgroup analyses and/or interaction terms (17, 61%), or latent class analysis (6, 21%) [29,33,40,46,51,52].…”

Section: Dcementioning

confidence: 99%

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Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Beckham

Crossnohere

Gross

et al. 2020

Patient

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Background Many human immunodeficiency virus (HIV) prevention technologies (pre-exposure prophylaxis, microbicides, vaccines) are available or in development. Preference elicitation methods provide insight into client preferences that may be used to optimize products and services. Given increased utilization of such methods in HIV prevention, this article identifies and reviews these methods and synthesizes their application to HIV prevention technologies. Methods In May 2020, we systematically searched peer-reviewed literature in PubMed, CINAHL, and Web of Science for studies employing quantitative preference elicitation methods to measure preferences for HIV prevention technologies among populations of any age, sex, or location. Quality assessment used an existing checklist (PREFS) and a novel adaptation of the Newcastle–Ottawa Scale (PROSPERO #CRD42018087027). Results We screened 5022 titles and abstracts, reviewed 318 full texts, and included 84 studies. Common methods employed were discrete-choice experiment (33%), conjoint analysis (25%), and willingness-to-participate/try/accept (21%). Studies were conducted in 25 countries and had a mean of 768 participants (range = 26–7176), two-thirds of them male. Common HIV prevention technologies included pre-exposure prophylaxis (23%), voluntary testing and counseling (19%), HIV self-testing (17%), vaccines (15%), and topical microbicides (9%). Most attributes focused on product design (side effects, frequency), service design (provider type, location), acceptability or willingness to accept/pay; results are summarized in these categories, by prevention type. Mean quality-adapted Newcastle–Ottawa Scale score was 4.5/8 (standard deviation = 2.1) and mean PREFS scores was 3.47/5 (standard deviation = 0.81). Conclusions This review synthesizes extant literature on quantitative measurement of preferences for HIV prevention technologies. This can enable practitioners to improve prevention products and interventions, and ultimately reduce HIV incidence.

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“…Nineteen studies examined PrEP [ 33 , 34 , 36 , 40 , 43 , 46 , 49 , 51 , 61 , 64 – 66 , 70 , 71 , 78 , 79 , 83 , 90 , 91 , 101 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Dcementioning

confidence: 99%

See 1 more Smart Citation

Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Beckham

Crossnohere

Gross

et al. 2020

Patient

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“…38 Interestingly, although women continue to have high rates of HIV acquisition in Sub-Saharan Africa, the majority were willing to exchange higher effectiveness for other desired attributes (such as the impact on vaginal wetness, pregnancy prevention and dosing regimen), according to a study of women in South Africa and Zimbabwe. 45 Research has shown that the perceptions of effectiveness among target populations influence the acceptance and in turn, the uptake of biomedical interventions. 46 Therefore, wider promotion of PrEP's high effectiveness may attract people to consider PrEP.…”

Section: Reviewmentioning

confidence: 99%

Preferences for pre-exposure prophylaxis for HIV: A systematic review of discrete choice experiments

Wulandari

Fairley

et al. 2022

eClinicalMedicine

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“…We described methods of long-acting HIV prevention currently pending regulatory approval or in development, and asked participants about preferences regarding HIV prevention modalities that may be available in the future. We adapted a list of PrEP characteristics from a discrete choice experiment of HIV prevention methods assessed within the Quatro Study [30]. We asked participants to rank the top three most important characteristics of a potential HIV prevention product, the top three most important accessrelated characteristics, and how frequently they would theoretically use an HIV prevention method.…”

Section: Current and Future Prep Preferencesmentioning

confidence: 99%

Preferences and Acceptability for Long-Acting PrEP Agents Among Pregnant and Postpartum Women with Experience Using Daily Oral PrEP in South Africa and Kenya

Wara

Mvududu

Marwa

et al. 2022

Preprint

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Introduction: Long-acting pre-exposure prophylaxis (PrEP) options could overcome some barriers to oral PrEP persistence during pregnancy and postpartum. We evaluated long-acting PrEP preferences among oral PrEP-experienced pregnant and postpartum women in South Africa and Kenya, two countries with high coverage of oral PrEP and with pending regulatory approvals for long-acting injectable cabotegravir and the dapivirine vaginal ring (approved in South Africa, under review in Kenya). Methods: From September 2021 to February 2022, we surveyed pregnant and postpartum women enrolled in oral PrEP studies in South Africa and Kenya. We evaluated oral PrEP attitudes and preferences for existing and future long-acting PrEP methods. Results: We surveyed 190 women in South Africa (67% postpartum; median age 27 years [IQR 22-32]) and 204 women in Kenya (79% postpartum; median age 29 years [IQR 25-33]). 75% of participants reported oral PrEP use within the last 30 days. Overall, 49% of participants reported negative oral PrEP attributes, including side effects (21% South Africa, 30% Kenya) and pill burden (20% South Africa, 25% Kenya). Preferred PrEP attributes included long-acting method, effectiveness, safety while pregnant and breastfeeding, and free medication. Most participants (75%, South Africa and Kenya) preferred a potential long-acting injectable over oral PrEP, most frequently for longer duration of effectiveness in South Africa (87% South Africa, 42% Kenya) versus discretion in Kenya (5% South Africa, 49% Kenya). 87% of participants preferred oral PrEP over a potential long-acting vaginal ring, mostly due to concern about possible discomfort with vaginal insertion (82% South Africa, 48% Kenya). Significant predictors of long-acting PrEP preference included past use of injectable contraceptive (aOR 2.48, 95% CI: 1.34, 4.57), disliking at least one oral PrEP attribute (aOR 1.72, 95% CI: 1.05, 2.80), and preferring infrequent PrEP use (aOR 1.58, 95% CI: 0.94, 2.65). Conclusions: Oral PrEP-experienced pregnant and postpartum women expressed a theoretical preference for long-acting injectable PrEP over other modalities, demonstrating potential acceptability among a key population who must be at the forefront of injectable PrEP rollout. Reasons for PrEP preferences differed by country, emphasizing the importance of increasing context-specific options and choice of PrEP modalities for pregnant and postpartum women.

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Efficacy is Not Everything: Eliciting Women’s Preferences for a Vaginal HIV Prevention Product Using a Discrete-Choice Experiment

Cited by 29 publications

References 31 publications

Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Preferences for pre-exposure prophylaxis for HIV: A systematic review of discrete choice experiments

Preferences and Acceptability for Long-Acting PrEP Agents Among Pregnant and Postpartum Women with Experience Using Daily Oral PrEP in South Africa and Kenya

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