End-User Research in Support of Long-Acting Systemic Antiretroviral Delivery Systems: Insights from Qualitative Research with Providers and Target Users in South Africa

Abstract

Background While oral pre-exposure prophylaxis (PrEP) has been shown to reduce the risk of HIV, challenges such as adhering to a daily-dosing regimen and persistence have emerged as barriers for at-risks populations in South Africa. This qualitative research sought to investigate perceptions of and preferences for a long-acting, biodegradable implantable PrEP product designed to address these barriers. Methods To identify and understand motivators, barriers, and preferences for the PrEP implant, we conducted qualitative in-depth interviews (IDIs) among health care providers (HCP) and target end-users (young women, adolescent girls, and female sex workers) in urban and rural regions of Gauteng Province, South Africa. The IDIs focused on defining values, beliefs, habits, lifestyles, influencers, and information channels for potential PrEP implant end-users. Results We conducted 36 IDIs across health care providers and target end-user respondent segments. Respondents had generally positive reactions to the PrEP implant. Most end-users felt that some undesirable aspects of the implant (e.g., side effects, pain during insertion, potential scarring, and dissolvability) would be offset by having a highly effective, and long-lasting HIV prevention product. Although some HCPs believed the implantable PrEP would lead to increases in promiscuity and risky sexual behavior, most HCPs saw value in the PrEP implant’s long duration of protection and the likelihood of higher adherence relative to oral PrEP. Conclusions While further research is necessary, this qualitative study demonstrates demand for a biodegradable, long-acting implantable PrEP and suggests such a product would be accepted by end-users and HCPs in South Africa. This study indicates the need to develop more convenient, discreet, long-acting, and highly effective biomedical HIV prevention options for at-risk populations.

Voluntary licensing of long‐acting HIV prevention and treatment regimens: using a proven collaboration‐ and competition‐based mechanism to rapidly expand at‐scale, sustainable, quality‐assured and affordable supplies in LMICs

“…It is critical to engage early and through the product lifecycle, with end‐user communities, caregivers and service delivery implementors (clinicians, nurses, pharmacists, community health workers and other people involved in delivering care) to include their perspectives, needs and preferences in the development of TPPs [ 35 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Product features defined by such TPPs should inform product design for compatibility with resource‐constrained settings, including to minimize the costs of starting materials as well as development, manufacturing, scale‐up, distribution, supply chain costs, and other downstream implementation and service delivery requirements and challenges.…”