ABSTRACT

Unintended pregnancy and unmet need for modern contraception contribute substantially to reproductive health disparities globally. In sub-Saharan Africa they occur in contexts of disproportionately high rates of HIV infection. Multipurpose prevention technologies (MPTs) can address HIV and pregnancy prevention needs in a single “2-in-1” product; however, few studies have solicited end-user views to inform design of new MPTs. We conducted the Tablets, Ring, Injections as Options (TRIO) study with young women aged 18−30 in Kenya and South Africa (N = 277) to examine preferences and acceptability of future MPTs. In a randomised clinical cross-over study in which women used three placebo delivery forms, we complemented quantitative acceptability assessments with in-depth interviews and focus group discussions (N = 88 participants). We examined anticipated enablers and barriers to adoption and use of future MPTs and synthesised novel product design recommendations. Participants expressed high interest in MPTs. Anticipated side effects constituted a primary concern; however, many expected barriers were not dosage form-specific, but addressed contextual factors instead, such as fears regarding use of new biomedical technologies, misunderstandings and stigma regarding use, and navigating partner disclosure and engagement. Women preferred MPTs that offered discreetness and long-duration protection to minimise user-burden, did not interfere with their relationships, and conferred protection for unanticipated situations. End-user research to identify and pre-emptively address potential barriers while underscoring benefits to a new MPT product is vital. Attention to cultural contexts in implementation of new MPTs is important to communicating perceived benefits, achieving acceptability and maximising public health benefits.

摘要

意外怀孕和现代避孕措施未得到满足的需求在很大程度上导致了全球生殖健康差异。在撒哈拉以南非洲，它们发生在艾滋病毒感染率高得不成比例的情况下。多用途预防技术 (MPT) 可以在单一的“二合一”产品中解决 HIV 和妊娠预防需求；然而，很少有研究征求最终用户的意见来指导新 MPT 的设计。我们对肯尼亚和南非 ( N  = 277) 的 18-30 岁年轻女性进行了片剂、戒指、注射作为选项 (TRIO) 研究，以检查未来 MPT 的偏好和可接受性。在一项随机临床交叉研究中，女性使用了三种安慰剂给药形式，我们通过深入访谈和焦点小组讨论补充了定量可接受性评估。ñ = 88 名参与者）。我们研究了采用和使用未来 MPT 的预期推动因素和障碍，并综合了新颖的产品设计建议。与会者对 MPT 表现出浓厚的兴趣。预期的副作用是主要问题；然而，许多预期的障碍并非特定于剂型，而是解决了环境因素，例如对使用新生物医学技术的恐惧、对使用的误解和污名化，以及引导合作伙伴披露和参与。女性更喜欢提供谨慎和长期保护的 MPT，以最大限度地减少用户负担，不干扰她们的关系，并为意外情况提供保护。最终用户研究以识别和先发制人地解决潜在障碍，同时强调新 MPT 产品的好处是至关重要的。