By Kudakwashe Pembere
This research comes on the back drop of a high HIV incidence and low adherence to daily oral PrEP among women underscoring the need for more acceptable and easier to use HIV prevention products. The study examined the acceptability of a long-acting injectable PrEP among HIV-uninfected women in Zimbabwe, South Africa and two United States phase 2 trial sites.
The study found that long-acting injectable PrEP is acceptable among African and US women experiencing product use.
“Acceptability of product attributes better predicted future interest in injectable use than experience of pain. This is reassuring as a single-dose regimen of a different product has advanced to phase 3 trials. Finally, the study suggests that future demand for an injectable PrEP by women may be greater in African than US settings, where the risk of HIV is highest,” read the study.
Global demand for injectable contraception suggests that new, long-acting, injectable formulations could meet this need.
“Several studies in African settings that assessed preferences among hypothetical or placebo PrEP products suggested that women’s acceptability of injectable products would be high, but that product choice and use patterns would also be shaped by individual and social context and geographies,” the research says.
Adds the research, “At baseline, 56% of US participants and 81% of African participants preferred using a bi-monthly injectable to other prevention methods, including daily oral pills, a vaginal ring or gel; interest increased in both regions over the study. At week 28, 79% of participants strongly endorsed the statement that they would “definitely use an injectable PrEP product for some time” if it were available in the future. Even more women (88%) strongly agreed that they would be “more interested in using an injectable if it was both for HIV and pregnancy prevention.”
According to the research women in the Zimbabwe Focus Group Discussion, while also describing monetary and health-related reasons, were more likely than those in the US and South African FGDs to mention altruistic reasons for joining the trial.
“I did not join for the sake of my life but for the sake of my fellows, such that even when I told my other relatives about it, they talked me out of it saying, ‘You will have side effects. You would die.’ and so forth. I gave them an example and said, ‘Isn’t it that when you were born, you were given those immunization injections?’ And she said, ‘Yes. ’ And I then asked, ‘Where did they begin? You do not know where they started from, so it is just the same,” says an unidentified woman quoted in the study.
In FGDs, women often described a complex decision-making process for trial participation. They weighed concerns about trial procedures and product use, as well as partner or family opposition, with personal benefits from monetary reimbursements and access to HIV testing and other medical procedures, and to their families and communities in terms of new prevention products. The emphasis on these different factors could vary. While multiple women in the US and Cape Town sites agreed that initially they decided to participate “for the money,” most added that other factors were also important. Some described first becoming aware of these other health benefits during prior HIV prevention trial participation, like this US participant:
“I feel like I am giving back to the community, like I am part of a group that helped find preventative methods for HIV. I was part of other research studies. But, it is true, the few extra dollars are a motivation,” said the US woman.