"Killing two birds with one stone" - a qualitative study on women's perspectives on the dual prevention pill in Johannesburg, South Africa.
End-users
HIV prevention
Multi-purpose prevention technology (MPT)
Pregnancy prevention
Qualitative research
South Africa
Journal
BMC women's health
ISSN: 1472-6874
Titre abrégé: BMC Womens Health
Pays: England
ID NLM: 101088690
Informations de publication
Date de publication:
22 Aug 2024
22 Aug 2024
Historique:
received:
06
11
2023
accepted:
17
07
2024
medline:
23
8
2024
pubmed:
23
8
2024
entrez:
22
8
2024
Statut:
epublish
Résumé
HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women in Johannesburg, South Africa. Between March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16-40 stratified by ages (16-17, 18-24, 25-40), half of whom were COC users. We explored adolescent girls and women's opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis. The majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient "two-in-one" solution, requiring one clinic visit for both PrEP and COCs. AGYW were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers. The DPP was perceived as acceptable for HIV and pregnancy prevention to AGYW in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence.
Sections du résumé
BACKGROUND
BACKGROUND
HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women in Johannesburg, South Africa.
METHODS
METHODS
Between March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16-40 stratified by ages (16-17, 18-24, 25-40), half of whom were COC users. We explored adolescent girls and women's opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis.
RESULTS
RESULTS
The majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient "two-in-one" solution, requiring one clinic visit for both PrEP and COCs. AGYW were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers.
CONCLUSIONS/SIGNIFICANCE
CONCLUSIONS
The DPP was perceived as acceptable for HIV and pregnancy prevention to AGYW in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence.
Identifiants
pubmed: 39174929
doi: 10.1186/s12905-024-03269-8
pii: 10.1186/s12905-024-03269-8
doi:
Substances chimiques
Contraceptives, Oral, Combined
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
462Subventions
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Organisme : WCG sub-agreement # 22010-202-440 in support of the Expanding Effective Contraceptive Options (EECO) project; US Agency for International Development (USAID) COOPERATIVE AGREEMENT # AID-OAA-A-13-00088 Children's Investment Fund Foundation (CIFF)
ID : R-1903-03681
Informations de copyright
© 2024. The Author(s).
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