Researchers borrow from behavioural economics to understand what women in sub-Saharan Africa really want from a pre-exposure prophylaxis (PrEP) product.
Young women in South Africa and Kenya would prefer injectable HIV prevention products that are multipurpose and can also prevent pregnancy over oral or ring-based pre-exposure prophylaxis (PrEP) products.
The findings were revealed in a ‘discrete choice experiment’ (DCE) conducted among 536 women aged 18-30 in South Africa and Kenya to determine what they wanted out of a PrEP product.
DCEs are a behavioural economics methodology that can be used to measure preferences for a biomedical product or medical treatment. They engage respondents in considering a set of features, or ‘attributes’, that make up a potential product, and then ask them to make choices that indicate the attributes and trade-offs most important to the product being used by the target group in the future.
Researchers looked specifically at how important HIV prevention, pregnancy prevention, product form, dosing frequency, and side-effects were to the women, giving them eight hypothetical products characterised by these parameters.
The DCE was conducted with participants from the TRIO (Tablet, Ring, Injection as Options) study which examines the acceptability of these three products. In this study, women were given either placebo vaginal rings, oral tablets and injections for one month each, after which they selected one to use for two further months. The DCE included women in this existing trial in addition to a group of newly recruited women who were product-naïve.
The analysis focused on three groups: product-experienced women in Kenya, product-naïve women in Kenya, and women in South Africa. This was because after an initial analysis, no difference was found in preferences of women in South Africa based on experience, so the group was combined.
Overall, HIV prevention was the most important product attribute for the women – with tablets as a delivery method the least preferred. For 20% of the women, product choice was dominated by HIV prevention efficacy, which was even more pronounced in the Kenya product-naïve sample (36%). For Kenyan women, product delivery wasn’t as important as the prevention effect, but for South African women, product delivery was equally important. For this group, having an injection every 2-3 months was the most preferred delivery, and monthly injections for product-experienced women in Kenya.
Overall, women preferred products that were multi-purpose for HIV and pregnancy prevention. When an injectable multi-purpose product was taken away, preferences for injectables decreased significantly, and more women preferred a multi-purpose vaginal ring, with little change for preference for tablets.
Young women in Africa are among the most affected groups for HIV globally. They face several socio-economic, cultural and structural challenges around HIV prevention and treatment and are in need of new, innovative solutions to fill this gap. Despite efficacy of a number of biomedical interventions, such as microbicides and PrEP, acceptability and real-world implementation of these products have so far been disappointing.
The authors commented, “Our findings underscore the benefit perceived by some women of an integrated MPT [multi-purpose prevention technology] product and provide additional evidence of the potential for increased choice to achieve expanded adoption of biomedical HIV prevention by young women. Indeed, expanding options to achieve choice in HIV prevention tools is essential to reaching prevention goals.”