Background: During MTN-020/ASPIRE, a phase III trial of the Dapivirine vaginal ring in Africa, preferences for various PrEP delivery forms (including the ring) were explored in a subsample of participants receiving exit in-depth interviews (IDIs).
Methods: Participants were presented with pictures and descriptions of 9 possible PrEP formulations (vaginal gel, ring, suppositories, and films; oral tablets, injections, implants, male and female condoms) and asked to discuss these, first in relation to the ring and second to select the formulations they would be most/least interested in for future use. IDIs were summarized in reports for rapid review of key findings; levels of interest in products were tabulated and themes related to product preference were extracted.
Results: In the qualitative subsample (N=71; Malawi n=12; South Africa n=34, Uganda n=13, Zimbabwe n=12), baseline median age was 26 (range 18-45 years), all had a primary sex partner; 41% reported using a male condom at last sex; the most common current contraceptives were injections (52%) and implants (24%). Participants expressed most interest for future PrEP formulated as rings (94%), implants (39%) and injections (34%). Positive attributes of these methods included being long-acting, discreet, familiar and easy-to-use. The ring was also liked for reliability, lack of side effects and comfort. Opinions were divided for implants and injections (28% and 32% uninterested in future use, respectively) due to needle-phobia, pain upon administration, low reversibility and fear of side effects based on previous contraceptive experience. Formulations participants had least interest in included: oral tablets (61%), vaginal gel (55%) and film (41%). Attributes of tablets that were disliked included the daily regimen, difficulty in swallowing and stigma related to taking HIV medicines. The gel, films and other vaginal formulations were disliked because of the act of vaginal insertion, coital use, effect on sex and lack of familiarity.
Conclusions: Diverse PrEP formulations elicited interest in this subsample, with long-acting methods being favored. Despite high interest in the vaginal ring, other vaginal products did not generate much interest. Familiarity, reliability, absence of side effects and low burden in terms of administration and use were determined as important attributes to consider for new PrEP formulations.