Preferences for Delivery of HIV Prevention Services Among Healthcare Users in South Africa: A Discrete Choice Experiment

Overview

Journal AIDS Behav

Specialty Infectious Diseases

Date 2024 Sep 30

PMID 39349906

Authors

Catherine Elizabeth Martin

Duane Blaauw

Pelisa Nongena

Glory Chidumwa

Siphokazi Dada

Samantha Jack

Vusile Butler

Saiqa Mullick

Affiliations

Soon will be listed here.

Abstract

Progress has been made to scale oral pre-exposure prophylaxis (PrEP) as part of combination HIV prevention, with the WHO recommending differentiated, simplified and demedicalized approaches. This study explored user preferences for components of a PrEP service delivery package, through a discrete choice experiment (DCE) among 307 people accessing primary healthcare services in South Africa between November 2022 and February 2023. Attributes included were: Source of information about HIV prevention and PrEP; Site for PrEP initiation and follow-up; Frequency of follow-up; PrEP pick-up point; HIV testing whilst using PrEP; Contact between appointments. A D-efficient DCE design was created with 16 choice sets in 2 blocks. DCE data were analysed using generalised multinomial logistic models. Compared to printed materials, participants preferred getting information about PrEP online (aOR = 7.73, 95% CI = 5.13-11.66) and through WhatsApp (aOR = 2.23, 95% CI = 0.98-5.55). PrEP initiation at a pharmacy or mobile clinic was valued equally to initiating PrEP at a clinic, but a community pop-up site was less preferred (aOR = 0.46, 95% CI = 0.33-0.64). There was a preference for 6-monthly over 3-monthly follow-up (aOR = 11.88, 95% CI = 5.44-25.94). Participants preferred collecting PrEP from a pharmacy (aOR = 5.02, 95% CI = 3.45-7.31), through home delivery (aOR = 2.18, 95% CI = 1.26-3.78) and from a vending machine (aOR = 1.43, 95% CI = 1.02-1.99) relative to where they initiated PrEP. Participants also preferred HIV self-testing over a healthcare provider test (aOR = 5.57, 95% CI = 3.72, 8.36). WhatsApp or Facebook groups (aOR = 4.12, 95% CI = 3.00-5.67), monthly phone calls (aOR = 2.84, 95% CI = 1.73-4.67) and weekly messages (aOR = 1.47, 95% CI = 1.10-1.97) were preferred contact between appointments, relative to no contact. To meet users' preferences, there is a need to expand decentralised and self-led HIV prevention services.

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References

Celum C, Bukusi E, Bekker L, Delany-Moretlwe S, Kidoguchi L, Omollo V . PrEP use and HIV seroconversion rates in adolescent girls and young women from Kenya and South Africa: the POWER demonstration project. J Int AIDS Soc. 2022; 25(7):e25962. PMC: 9278271. DOI: 10.1002/jia2.25962. View

Martin C, Cox L, Nongena P, Butler V, Ncube S, Sawry S . Patterns of HIV Pre-exposure Prophylaxis use Among Adolescent Girls and Young Women Accessing Routine Sexual and Reproductive Health services in South Africa. J Adolesc Health. 2023; 73(6S):S81-S91. DOI: 10.1016/j.jadohealth.2023.08.004. View

Cox L, Martin C, Nongena P, Mvelase S, Kutywayo A, Mullick S . The Use of HIV Pre-exposure Prophylaxis Among Men Accessing Routine Sexual and Reproductive Health Services in South Africa. J Adolesc Health. 2023; 73(6S):S92-S100. DOI: 10.1016/j.jadohealth.2023.08.017. View

Muhumuza R, Ssemata A, Kakande A, Ahmed N, Atujuna M, Nomvuyo M . Exploring Perceived Barriers and Facilitators of PrEP Uptake among Young People in Uganda, Zimbabwe, and South Africa. Arch Sex Behav. 2021; 50(4):1729-1742. PMC: 8213546. DOI: 10.1007/s10508-020-01880-y. View

Mudzingwa E, de Vos L, Atujuna M, Fynn L, Mugore M, Hosek S . Factors influencing adolescent girls and young women's uptake of community-based PrEP services following home-based HIV testing in Eastern Cape, South Africa: a qualitative study. AIDS Behav. 2022; 26(11):3726-3739. DOI: 10.1007/s10461-022-03702-9. View

Beesham I, Heffron R, Evans S, Baeten J, Smit J, Beksinska M . Exploring the Use of Oral Pre-exposure Prophylaxis (PrEP) Among Women from Durban, South Africa as Part of the HIV Prevention Package in a Clinical Trial. AIDS Behav. 2020; 25(4):1112-1119. PMC: 7973915. DOI: 10.1007/s10461-020-03072-0. View

Rousseau E, Bekker L, Julies R, Celum C, Morton J, Johnson R . A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa. BMC Health Serv Res. 2021; 21(1):888. PMC: 8403426. DOI: 10.1186/s12913-021-06920-4. View

Butler V, Kutywayo A, Martin C, Pleaner M, Mojapele M, Ncube S . Implementing Differentiated and Integrated HIV Prevention Services for Adolescent Girls and Young Women: Experiences From Oral PrEP Rollout in Primary Care Services in South Africa. J Adolesc Health. 2023; 73(6S):S58-S66. DOI: 10.1016/j.jadohealth.2023.09.003. View

Medina-Marino A, Bezuidenhout D, Ngwepe P, Bezuidenhout C, Facente S, Mabandla S . Acceptability and feasibility of leveraging community-based HIV counselling and testing platforms for same-day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa. J Int AIDS Soc. 2022; 25(7):e25968. PMC: 9309460. DOI: 10.1002/jia2.25968. View

10.

Grammatico M, Moll A, Choi K, Springer S, Shenoi S . Feasibility of a community-based delivery model for HIV pre-exposure prophylaxis among bar patrons in rural South Africa. J Int AIDS Soc. 2021; 24(11):e25848. PMC: 8625837. DOI: 10.1002/jia2.25848. View

11.

Kennedy C, Yeh P, Atkins K, Ferguson L, Baggaley R, Narasimhan M . PrEP distribution in pharmacies: a systematic review. BMJ Open. 2022; 12(2):e054121. PMC: 8860049. DOI: 10.1136/bmjopen-2021-054121. View

12.

Celum C, Delany-Moretlwe S, Baeten J, van der Straten A, Hosek S, Bukusi E . HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019; 22 Suppl 4:e25298. PMC: 6643076. DOI: 10.1002/jia2.25298. View

13.

de Bekker-Grob E, Ryan M, Gerard K . Discrete choice experiments in health economics: a review of the literature. Health Econ. 2012; 21(2):145-72. DOI: 10.1002/hec.1697. View

14.

Wang Y, Wang Z, Wang Z, Li X, Pang X, Wang S . Application of Discrete Choice Experiment in Health Care: A Bibliometric Analysis. Front Public Health. 2021; 9:673698. PMC: 8212992. DOI: 10.3389/fpubh.2021.673698. View

14.

de Dieu Tapsoba J, Zangeneh S, Appelmans E, Pasalar S, Mori K, Peng L . Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya. AIDS Care. 2020; 33(6):712-720. PMC: 7981281. DOI: 10.1080/09540121.2020.1822505. View

15.

Harris P, Taylor R, Minor B, Elliott V, Fernandez M, ONeal L . The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95:103208. PMC: 7254481. DOI: 10.1016/j.jbi.2019.103208. View

16.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

17.

Budhwani H, Kiszla B, Hightow-Weidman L . Adapting digital health interventions for the evolving HIV landscape: examples to support prevention and treatment research. Curr Opin HIV AIDS. 2022; 17(2):112-118. PMC: 9833493. DOI: 10.1097/COH.0000000000000721. View

18.

Cao B, Bao H, Oppong E, Feng S, Smith K, Tucker J . Digital health for sexually transmitted infection and HIV services: a global scoping review. Curr Opin Infect Dis. 2019; 33(1):44-50. PMC: 7152691. DOI: 10.1097/QCO.0000000000000619. View

19.

Fitzpatrick C, Richardson D, Sherriff N, Whetham J . Pilot evaluation of PrEP EmERGE - A novel digital health innovation designed to support sexual health clinics and HIV-PrEP users. HIV Med. 2022; 24(4):502-506. DOI: 10.1111/hiv.13406. View