Preferences for Multipurpose Technology and Non-oral Methods of Antiretroviral Therapy Among Women Living With HIV in Western Kenya: A Survey Study

Abstract

IntroductionUnderstanding interests in and preferences for multipurpose technology (MPT) for the co-administration of contraception and antiretroviral therapy (ART) and alternative, non-oral ART methods among women living with HIV (WLHIV) is vital to successful implementation of future treatment options, such as long-acting injectable ART.MethodsBetween May 2016 and March 2017 we conducted a cross-sectional telephone survey of 1,132 WLHIV of reproductive potential with prior experience using intermediate- or long-acting contraceptive methods in western Kenya. We present descriptive statistics and multinomial logistic regression to evaluate predictors of interest in specific MPT and non-oral ART methods.ResultsTwo-thirds (67%) reported interest in MPT, with the most common reason for interest being ease of using a single medication for both purposes of HIV treatment and pregnancy prevention (26%). Main reasons for lack of interest in MPT were need to stop/not use contraception while continuing ART (21%) and risk of side effects (16%). Important characteristics of MPT were effectiveness for pregnancy prevention (26%) and HIV treatment (24%) and less than daily dosing (19%). Important characteristics of non-oral ART methods were less than daily dosing (47%), saving time accessing ART (16%), and effectiveness of HIV treatment (15%). The leading preferred methods for both MPT and non-oral ART were injectables (50 and 54%) and implants (32 and 31%). Prior use of a contraceptive implant or injectable predicted interest in similar methods for both MPT and non-oral ART methods, while this relationship did not appear to vary between younger vs. older WLHIV.DiscussionMost WLHIV in western Kenya are interested in MPT for HIV treatment and contraception. Prior exposure to contraceptive implants or injectables appears to predict interest in similar methods of MPT and non-oral ART. Developers of MPT and non-oral ART methods should strongly consider WLHIV's preferences, including their changing reproductive desires.

Preferences for Long-Acting PrEP Products Among Women and Girls: A Quantitative Survey and Discrete Choice Experiment in Eswatini, Kenya, and South Africa

“…Another modeling study from South Africa found that provision of long-acting PrEP delivery to all HIV-negative injectable contraceptive users would be cost-effective at low drug prices, or when targeted to high-risk women [ 51 ]. As with previous research [ 46 – 48 ], preferences for MPTs in our study diminished under circumstances where side-effects (including menstrual changes) were greater with a dual-protection than a single indication product, and with formats that could not be stopped/removed if dual-protection was no longer needed or desired, highlighting trade-offs of choosing an MPT product. However, dual-protection products are unlikely to have more side effects than two separate single-indication products administered together.…”

“…Development of multi-purpose prevention technologies (MPTs) has accelerated in recent years, with several products in the development pipeline including both long-acting and on-demand options [ 44 , 45 ]. MPTs have the potential to both better appeal to target end-users ( 46 – 48 ) and to be cost-effective [ 49 ] relative to single-indication products. A recent costing study found that MPTs, including long-acting injectable antiretrovirals (ARVs), would likely be cost-effective among female sex workers and young women ages 16–24 in South Africa [ 50 ].…”

Microarray patch for HIV prevention and as a multipurpose prevention technology to prevent HIV and unplanned pregnancy: an assessment of potential acceptability, usability, and programmatic fit in Kenya

“…FSW wanted duration of protection consistent with injectable contraception. Other user groups, such as women living with HIV, have also identified a longer-acting injectable as preferred over daily oral tablets when a multipurpose technology concept offered an antiretroviral for HIV treatment co-administered with a hormonal contraceptive ( 40 ). However, this may reflect respondent bias in that injectable contraception is well accepted in Kenya, thereby making it a familiar benchmark technology.…”