Systematic review of the values and preferences regarding the use of injectable pre‐exposure prophylaxis to prevent HIV acquisition

Lorenzetti, Lara; Dinh, Nhi; Straten, Ariane van der; Fonner, Virginia A.; Ridgeway, Kathleen; Rodolph, Michelle; Schaefer, Robin; Schmidt, H; Baggaley, Rachel

doi:10.1002/jia2.26107

Cited by 21 publications

(12 citation statements)

References 85 publications

(280 reference statements)

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“…Our updated model has been parameterized using recent data from a PrEP cohort study conducted among pregnant and postpartum women in South Africa, which shows reasonable oral PrEP uptake but limited adherence and continuation [5,7,15]. In this context, CAB-LA could potentially be very important, reducing HIV incidence in PBW by around 40%, and reducing vertical transmission by around 24% – a reflection of both greater acceptability of injectable prevention methods [22–24] and superior efficacy [9]. Offering a choice of CAB-LA and oral PrEP would lead to the greatest PrEP uptake (consistent with the effect of choice in family planning [25]), but the impact on HIV transmission would not differ materially from offering CAB-LA alone.…”

Section: Discussionmentioning

confidence: 95%

The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants

Johnson,

Myer,

Jamieson

et al. 2023

Aids

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Background: Pregnant and breastfeeding women (PBW) in sub-Saharan Africa have high HIV incidence rates and associated risk of vertical transmission to their infants. Oral pre-exposure prophylaxis (PrEP) and injectable PrEP (long-acting cabotegravir, or CAB-LA) can potentially reduce this HIV transmission, but population-level impacts are uncertain. Methods: We extended a previously-developed model of HIV and PrEP in South Africa to allow for variable PrEP duration and preference in PBW. We considered three potential scenarios for PrEP provision to PBW: oral PrEP only, CAB-LA only and allowing oral/CAB-LA choice, with uptake and retention assumptions informed by South African data, each compared to a ‘base’ scenario without PrEP for PBW. Results: Without PrEP for PBW, the model estimates 1.31 million new infections will occur between 2025 and 2035 in South African adults and children, including 100,000 in PBW, 16,800 in infants at/before birth, and 35,200 in children through breastmilk. In the oral PrEP only scenario, these numbers would reduce by 1.2% (95% CI: 0.7–1.7%), 8.6% (4.8–12.9%), 4.0% (2.1–5.8%) and 5.3% (3.0–8.2%) respectively. In the CAB-LA only scenario, the corresponding reductions would be 6.1% (2.9–9.6%), 41.2% (19.8–65.0%), 12.6% (6.0–19.4%) and 29.5% (13.9–46.8%) respectively, and in the oral/CAB-LA choice scenario, similar reductions would be achieved (5.6% [3.4–8.0%], 39.0% [23.4–55.9%], 12.4% [7.4–16.8%] and 27.6% [16.5–39.9%] respectively). Conclusion: CAB-LA has the potential to be substantially more effective than oral PrEP in preventing HIV acquisition in PBW and vertical transmission, and can also modestly reduce HIV incidence at a population level.

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Section: Discussionmentioning

confidence: 95%

The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants

Johnson,

Myer,

Jamieson

et al. 2023

Aids

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“…A previously published review assessed values and preferences for long-acting injectable PrEP; however, most studies included were published on or before October 2021, before regulatory approval of the first long-acting ARV for use as PrEP, CAB-LA [36]. Authors found broad interest in and overall preference for LAIs and highlighted the perceived benefits of discretion and less frequent dosing.…”

Section: Discussionmentioning

confidence: 99%

User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

Pfau,

Saravis BA,

Cox

et al. 2024

Preprint

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Structured AbstractBackgroundNovel formulations for PrEP such as injectables, implants, and intravaginal rings are emerging as long-acting alternatives to daily pills for the prevention of HIV. Sub-Saharan Africa has the highest HIV burden as well as the highest PrEP coverage globally. As long-acting formulations continue to become available, it is crucial to understand the product preferences of potential users.ObjectiveTo conduct a scoping review focused on the region of Sub-Saharan Africa to understand which PrEP products, especially long-acting formulations, different patients and demographic groups prefer as well as the factors that influence their preferences.DesignWe identified 34 publications published between 2014 and 2024 that assessed preferences regarding at least one long-acting PrEP product in the region of Sub-Saharan Africa.ResultsParticipants preferred longer-acting products over oral pills when given the choice in almost all studies. On-demand PrEP was commonly preferred over daily dosing, and long-acting products were preferred over on-demand dosing. A majority of studies found injectables to be most commonly preferred compared to daily oral PrEP, implants, and rings. This preference was observed across a range of demographics including men and women, youth, men who have sex with men, and female sex workers. Duration, efficacy, and discretion were the three most important factors influencing participants’ choices.ConclusionsLong-acting products, especially injectables, are acceptable for a wide range of individuals at risk of HIV in Sub-Saharan Africa and tend to be preferred over daily oral pills. Participants expressed a diversity of values and opinions regarding preferences, emphasizing the benefit of providing multiple formulations to maximize coverage over heterogeneous populations.Strength and Limitations of this StudySome key populations, such as transgender women, were underrepresented in the literature. With most studies published before long-acting products became widely available, the hypothetical preferences of non-experienced users may differ from preferences in practice.

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“…1 University of Pennsylvania, Philadelphia, Pennsylvania, USA; 2 Bridge HIV at the San Francisco Department of Public Health, San Francisco, California, USA; 3 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; 4 University of Alabama at Birmingham, Birmingham, Alabama, USA;…”

Section: A U T H O R S ' a F F I L I At I O N Smentioning

confidence: 99%

A conjoint experiment of three placebo rectal products used with receptive anal sex: results from MTN‐035

Bauermeister,

Lin,

Tingler

et al. 2024

J Int AIDS Soc.

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IntroductionEnd‐user perspectives are vital to the design of new biomedical HIV prevention products. Conjoint analysis can support the integration of end‐user perspectives by examining their preferences of potential pre‐exposure prophylaxis (PrEP) products. The Microbicides Trial Network (MTN) 035 protocol examined three placebo rectal dosage forms (insert, enema and suppository) that could deliver PrEP prior to receptive anal sex (RAS).MethodsBetween April 2019 and July 2020, we enrolled 217 HIV‐negative, cisgender men who have sex with men (MSM; n = 172; 79.3%) and transgender people (n = 47; 20.7%) ages 18–35 into a randomized cross‐over trial across Malawi, Peru, South Africa, Thailand and the United States. Participants used each product prior to RAS over 4‐week periods. Participants completed a conjoint experiment where they selected between random profiles using seven features (dosage form, timing of use before sex, side effects, duration of protection, effectiveness, frequency of use and need for a prescription).ResultsEffectiveness was the strongest determinant of choice (30.4%), followed by modality (18.0%), potential side effects (17.2%), frequency of use (10.8%), duration of protection (10.4%), timing of use before sex (7.4%) and need for a prescription (5.9%). Relative utility scores indicated that the most desirable combination of attributes was a product with 95% efficacy, used 30 minutes before sex, offering a 3‐ to 5‐day protection window, used weekly, having no side effects, in the form of an enema and available over‐the‐counter.ConclusionsChoice in next‐generation PrEP products is highly desired by MSM and transgender people, as no one‐size‐fits‐all approach satisfies all the preferences. MTN‐035 participants weighed product features differently, recognizing the need for diverse, behaviourally congruent biomedical options that fit the needs of intended end‐users.

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Systematic review of the values and preferences regarding the use of injectable pre‐exposure prophylaxis to prevent HIV acquisition

Cited by 21 publications

References 85 publications

The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants

The potential benefits of long-acting injectable cabotegravir in pregnant and breastfeeding women and their infants

User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

A conjoint experiment of three placebo rectal products used with receptive anal sex: results from MTN‐035

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