BACKGROUND: Uptake and sustained adherence to HIV prevention methods is a widely recognized challenge that long-acting injectable and implantable approaches aim to overcome. Youth are a key end-user target population for these methods. Examination of product attributes and preferences that might impact youth''s adherence provides an opportunity to inform product development and optimize the potential impact of long-acting HIV prevention methods.
METHODS: In Cape Town, 50 in-depth interviews with male (n=18) and female (n=32) youth aged 18-25 were conducted in English or Xhosa by trained social scientists. Interview guides used a socio-ecological framework to explore external factors at the individual, interpersonal, and structural levels influencing uptake of and adherence to prevention technologies as well as preferences for specific product attributes. We purposively selected youth with a variety of HIV prevention product experience including oral PrEP (n=28; 10 female); injectable PrEP (12 female), or the vaginal ring (10 female), to ensure participants could provide opinions rooted in actual experience.
RESULTS: Participants averaged 22 years of age, 97% have sex only with men (14 male, 31 female). Irrespective of previous method-use experience, gender, or sexual orientation, participants expressed preference for injectables and implants, compared to other methods, because of their longer duration, increased discretion and reduced stigma. Systemic absorption (“it stays in the body”) resonated with youth. Attributes suggesting dimensions of “invisibility” were favored: e.g. effortless flow through the body for extended periods; pain-free with no side effects; products that would not be noticed or felt by friends, family, partners or community-members nor necessitate disclosure. Although still favored, implants were perceived as less “invisible” due to concerns that rods would move inside the body or cause visible scarring that would reveal usage. Several youth expressed concerns about gang members attacking an implant-user to cut out, steal and smoke the drug in the implant.
CONCLUSIONS: Several attributes of long-acting HIV prevention methods were perceived as important to young South African end-users, and will be used to quantitatively assess relative preferences and attribute trade-offs in a follow-on discrete choice survey. End-user preferences of attributes can be used to inform product development and testing to optimize adherence among youth.
