BACKGROUND: End-user input is needed to inform development of MPT products, combining PrEP and contraception, to maximize uptake and use. We compared ratings of three placebo MPT delivery forms after use among young women in Kenya and South Africa and examined factors associated with product ratings.
METHODS: The TRIO Study enrolled 277 HIV-negative, sexually active, non-pregnant women aged 18-30 in a randomized cross-over study to use each placebo MPT (daily oral tablets, monthly vaginal rings and monthly injections) for one month. At the end of each use period, we asked participants to rate how much they liked the product on a 5-point Likert scale (1=low) and assessed participant opinions of product attributes. We compared mean ratings for each product using paired t-tests and used multivariable linear regression to examine attribute- and behavior-related characteristics associated with ratings for each product, adjusting for age, site and randomization group.
RESULTS: Mean age was 23.2 years. Mean product ratings increased for all products after the one-month period of use, with the greatest increase (1 point, p< 0.001) for rings, the least familiar product. After use, mean rating were significantly higher for injections (4.3 [SD=1.0]) compared with tablets (3.0 [SD=1.3]) and rings (3.3 [SD=1.4]) (p< 0.001); mean ratings for rings were significantly higher than for tablets (p=0.015). Ratings did not vary by age, but Kenyan women (vs. South African) reported a higher rating for tablets (3.2 vs. 2.7, p=0.005) and a lower rating for rings (3.1 vs. 3.5, p=0.042). In multivariable analysis, acceptability of key product characteristics (look, ease of use and interference with normal activities) were each associated with a significant increase of ≥1 point in the mean rating across all three products (p≤0.001). Product use without partner knowledge was associated with a higher mean rating for rings (b=0.50; p=0.006) but not for tablets or injections.
CONCLUSIONS: After a one-month period of use, young women rated injections most highly among three placebo MPT delivery forms, and rated rings more favorably than tablets. The acceptability of product attributes contributed significantly to the rating of all products, highlighting the value of choice in HIV prevention to accommodate diverse users.
