HIV prevention is not all about HIV – using a discrete choice experiment among women to model how the uptake and effectiveness of HIV prevention products may also rely on pregnancy and STI protection

Abstract Introduction In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI). Methods A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women’s HIV acquisition risk. Results In adolescent women, there will be limited uptake (< 6% for any product) and impact (< 4% decrease in HIV acquisition risk) of new products unless they provide pregnancy protection, which could quadruple use and impact. Adult women have weaker preference for pregnancy protection, with moderate use (< 17% for each) and impact (< 14 percentage point decrease) if they only provide HIV protection. All women had highest preference for injectable ARVs, with oral PrEP having high preference if injectable ARVs are not available. Adult women will use the ring, but adolescent women will not. Importantly, even with three additional prevention products, all providing pregnancy and STI protection, > 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain. Conclusions Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women.

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PS47 Could Improved Training Opportunities Reduce Health Workforce Migration From Sub-Saharan Africa? Evidence From A Discrete Choice Experiment Among Pharmacists

Journal of Epidemiology & Community Health ◽

10.1136/jech-2012-201753.146 ◽

2012 ◽

Vol 66 (Suppl 1) ◽

pp. A56.2-A56

Author(s):

G Stynes ◽

M Oketch ◽

F Smith ◽

R Smith ◽

R Owusu-Daaku ◽

...

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Health Workforce ◽

Choice Experiment ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Training Opportunities ◽

Health Workforce Migration

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Patient Preferences and Willingness to Pay for Cervical Cancer Prevention in Zambia: Protocol for a Multi-Cohort Discrete Choice Experiment (Preprint)

10.2196/preprints.10429 ◽

2018 ◽

Author(s):

Sujha Subramanian ◽

Yevgeniya Kaganova ◽

Yuying Zhang ◽

Sonja Hoover ◽

Namakau Nyambe ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Willingness To Pay ◽

Cervical Cancer Screening ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Sub Saharan Africa ◽

Screening Programs ◽

Sub Saharan

BACKGROUND Although most countries in southern Africa have cervical cancer screening programs, these programs generally fail to reach a significant majority of women because they are often implemented as pilot or research projects, and this limits their scope and ability to scale up screening. Some countries have planned larger-scale programs, but these have either never been implemented or have not been successfully scaled up. Most of the global burden of cervical cancer is experienced in countries with limited resources, and mortality from cervical cancer is the most common cause of cancer-related deaths among women in Sub-Saharan Africa. OBJECTIVE The purpose of this study is to learn about preferences for cervical cancer screening in Zambia, to identify barriers and facilitators for screening uptake, and to evaluate willingness to pay for screening services to support the scaling up of cervical cancer screening programs. METHODS We will conduct a discrete choice experiment by interviewing women and men and asking them to choose among constructed scenarios with varying combinations of attributes relevant to cervical cancer screening. To inform the discrete choice experiment, we will conduct focus groups and interviews about general knowledge and attitudes about cervical screening, perception about the availability of screening, stigma associated with cancer and HIV, and payment for health care services. For the discrete choice experiment, we will have a maximum design of 120 choice sets divided into 15 sets of 8 tasks each with a sample size of 320-400 respondents. We will use a hierarchical Bayesian estimation procedure to assess attributes at the following two levels: group and individual levels. RESULTS The model will generate preferences for attributes to assess the most important features and allow for the assessment of differences among cohorts. We will conduct policy simulations reflecting potential changes in the attributes of the screening facilities and calculate the projected changes in preference for choosing to undergo cervical cancer screening. The findings from the discrete choice experiment will be supplemented with interviews, focus groups, and patient surveys to ensure a comprehensive and context-based interpretation of the results. CONCLUSIONS Because willingness to pay for cervical cancer screening has not been previously assessed, this will be a unique and important contribution to the literature. This study will take into account the high HIV prevalence in Sub-Saharan Africa and prevailing gender attitudes to identify an optimal package of interventions to reduce cervical cancer incidence. This simulation of women’s decisions (and men’s support) to undergo screening will lay the foundation for understanding the stated preferences and willingness to pay to help design future screening programs. REGISTERED REPORT IDENTIFIER RR1-10.2196/10429

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How Much Demand for New HIV Prevention Technologies Can We Really Expect? Results from a Discrete Choice Experiment in South Africa

PLoS ONE ◽

10.1371/journal.pone.0083193 ◽

2013 ◽

Vol 8 (12) ◽

pp. e83193 ◽

Cited By ~ 32

Author(s):

Fern Terris-Prestholt ◽

Kara Hanson ◽

Catherine MacPhail ◽

Peter Vickerman ◽

Helen Rees ◽

...

Keyword(s):

South Africa ◽

Hiv Prevention ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment

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Multiple sexual partnerships among female adolescents in rural Uganda: the effects of family structure and school attendance

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2014-0032 ◽

2015 ◽

Vol 27 (3) ◽

pp. 319-328 ◽

Cited By ~ 3

Author(s):

Nanlesta A. Pilgrim ◽

Saifuddin Ahmed ◽

Ronald H. Gray ◽

Joseph Sekasanvu ◽

Tom Lutalo ◽

...

Keyword(s):

Family Structure ◽

School Attendance ◽

Sexual Partners ◽

Sub Saharan Africa ◽

Female Adolescents ◽

Biological Father ◽

Adolescent Women ◽

Sub Saharan ◽

Hiv Acquisition ◽

Multiple Sexual Partnerships

Abstract Background: A better understanding is needed of the contextual factors that influence HIV risk behaviors among female adolescents in sub-Saharan Africa. The objectives of this study were to assess the influence of family structure on lifetime sexual partners and on the number of sexual partners in the last year among female adolescents in rural Rakai, Uganda. In addition, the study assessed whether the influence of family structure on these outcomes differed by the school attendance status of the adolescents. Methods: The sample consisted of 2337 unmarried adolescent girls, aged 15–19, enrolled in the Rakai Community Cohort Study. The last survey interview within the time period of 2001–2008 available for each girl was used. Analyses were stratified by age (15–17 year olds and 18–19 year olds) and school status. Multinomial logistic and poisson regressions were used. Results: Living in a household with a biological father was protective against both outcomes. Family structure was not associated with the outcomes among in-school adolescents but it was significantly associated with the outcomes among out-of-school adolescents. Conclusion: The findings suggest that understanding the familial context in which female adolescents develop, as well as its interaction with school attendance, is important for HIV prevention efforts. Both research and programmatic initiatives must consider the interplay between the family and school domains when considering ways to reduce HIV acquisition among adolescent women.

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Preferences regarding emerging HIV prevention technologies among Toronto men who have sex with men: a discrete choice experiment

Scientific Reports ◽

10.1038/s41598-021-01634-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Darrell H. S. Tan ◽

Jayoti Rana ◽

Zavare Tengra ◽

Trevor A. Hart ◽

James Wilton ◽

...

Keyword(s):

Drug Resistance ◽

Hiv Prevention ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Marginal Rate ◽

On Demand ◽

Marginal Rate Of Substitution ◽

Sex With Men ◽

Long Acting

AbstractNew forms of HIV pre-exposure prophylaxis (PrEP) include long-acting injectables and topical microbicides, each with unique attributes that may appeal to distinct users. We used a discrete choice experiment to characterize preferences for new PrEP formulations among Toronto men who have sex with men. MSM undergoing anonymous HIV testing completed a discrete choice experiment with 12 choice sets by selecting their preferred option within each set. Each set included “usual methods to prevent HIV” (excluding PrEP) as one alternative and two hypothetical PrEP alternatives, which differed according formulation/dosing, side effects (none/mild), risk of drug resistance (none/low/moderate), and HIV prevention efficacy (50%, 65%, 80% or 99% risk reduction). We used mixed logistic regression to infer preferences for PrEP attributes and calculate the marginal rate of substitution between efficacy and other PrEP attributes. 306 men with median (interquartile range) age = 29 (25, 36) years participated, and reported 6 (3, 10) partners and 0 (0, 2) condomless receptive anal sex acts in the preceding six months. An on-demand pill was the most preferred formulation, followed by a monthly injection, daily pill, and on-demand rectal gel. Drug resistance was an important determinant of preferences if the risk was moderate, but not if it was low. The minimum efficacy required for an on-demand pill to be preferred over no PrEP was 32.6% (95%CI = 21.2–43.9%); for a daily pill, injections, and rectal gel, minimum efficacy was 57.9% (95%CI = 44.1–71.7%), 40.1% (27.0–53.2%), and 71.3% (60.5–82.1%), respectively. Attitudes towards PrEP formulations vary among men who have sex with men, with on-demand pills and monthly injections having the highest average preference scores. Understanding these preferences may help to predict uptake.

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Efficacy is Not Everything: Eliciting Women’s Preferences for a Vaginal HIV Prevention Product Using a Discrete-Choice Experiment

AIDS and Behavior ◽

10.1007/s10461-019-02715-1 ◽

2019 ◽

Vol 24 (5) ◽

pp. 1443-1451 ◽

Cited By ~ 1

Author(s):

Erica N. Browne ◽

Elizabeth T. Montgomery ◽

Carol Mansfield ◽

Marco Boeri ◽

Brennan Mange ◽

...

Keyword(s):

Hiv Prevention ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Pregnancy Prevention ◽

Stated Choice ◽

Community Members ◽

Two Samples ◽

Choice Sets ◽

Women’S Preferences

Abstract As new female-initiated HIV prevention products enter development, it is crucial to incorporate women’s preferences to ensure products will be desired, accepted, and used. A discrete-choice experiment was designed to assess the relative importance of six attributes to stated choice of a vaginally delivered HIV prevention product. Sexually active women in South Africa and Zimbabwe aged 18–30 were recruited from two samples: product-experienced women from a randomized trial of four vaginal placebo forms and product-naïve community members. In a tablet-administered survey, 395 women chose between two hypothetical products over eight choice sets. Efficacy was the most important, but there were identifiable preferences among other attributes. Women preferred a product that also prevented pregnancy and caused some wetness (p < 0.001). They disliked a daily-use product (p = 0.002) and insertion by finger (p = 0.002). Although efficacy drove preference, wetness, pregnancy prevention, and dosing regimen were influential to stated choice of a product, and women were willing to trade some level of efficacy to have other more desired attributes.

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Divergent Preferences for HIV Prevention: A Discrete Choice Experiment for Multipurpose HIV Prevention Products in South Africa

Medical Decision Making ◽

10.1177/0272989x17729376 ◽

2017 ◽

Vol 38 (1) ◽

pp. 120-133 ◽

Cited By ~ 27

Author(s):

Matthew Quaife ◽

Robyn Eakle ◽

Maria A. Cabrera Escobar ◽

Peter Vickerman ◽

Maggie Kilbourne-Brook ◽

...

Keyword(s):

South Africa ◽

Hiv Prevention ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment

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Ask the Way From Those Who Have Walked It Before – Grandmothers’ Roles in Health-related Decision Making and HIV Pre-exposure Prophylaxis (PrEP) Use Among Pregnant and Breastfeeding Women in Africa

10.21203/rs.3.rs-459256/v1 ◽

2021 ◽

Author(s):

Krishnaveni Reddy ◽

Doreen Kemigisha ◽

Miria Chitukuta ◽

Sufia Dadabhai ◽

Florence Mathebula ◽

...

Keyword(s):

Hiv Prevention ◽

Sub Saharan Africa ◽

Sources Of Information ◽

Maternal Experience ◽

Biomedical Hiv Prevention ◽

Health Related ◽

Sub Saharan ◽

Hiv Acquisition ◽

The Right ◽

Exposure Prophylaxis

Abstract Background: HIV acquisition among pregnant and breastfeeding women in sub-Saharan Africa (SSA) and vertical transmission rates remain high despite established strategies for HIV prevention. Methods: We explored grandmothers’ (mothers/mothers-in-law) influence on pregnant and breastfeeding women’s health-related decisions and their potential to support use of HIV prevention products utilizing qualitative data collected from grandmothers, HIV-uninfected, currently/recently pregnant or breastfeeding women and male partners of currently/recently pregnant or breastfeeding women during the MTN-041/MAMMA study. Results: Grandmothers were described as important sources of information, playing both supportive and influencer roles, due to personal maternal experience and generational knowledge. Grandmothers expressed willingness to support pre-exposure prophylaxis (PrEP) use and agreed with other groups that this decision should be made by women themselves and/or with partners. Conclusion: With the right framing and approach, grandmothers’ supportive roles can optimise uptake and adherence to biomedical HIV prevention and reduce HIV acquisition among pregnant and breastfeeding women in these communities.

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