What women want - results from discrete choice experiment about preferred PrEP method from Khomas region of Namibia


BACKGROUND: Adherence to Pre-exposure Prophylaxis to reduce new HIV infection among Adolescent Girls and Young Women (AGYW) of age 10 to 24 years remains a critical challenge. Under the USAID/Namibia-funded DREAMS project, PrEP is offered as part of the package with limited continuation.
Besides daily oral PrEP, with recent positive results from HPTN-084 on Cabotegravir Long-Acting Injectable (CAB-LA) and WHO approval of Dapivirine Vaginal Ring (DAP-VR), this study had an objective to take end-user perspectives on their preferred PrEP method of choice.
METHODS: A survey was conducted using a convenient sampling method with 1,675 active AGYW from the Khomas region. The interview questions included demographics, PrEP knowledge, attitude, practices, and preferred PrEP options. Before the PrEP preferred options section was administered, DREAMS Nurses used visual and narrative descriptions to educate AGYW on the attributes of PrEP options (i.e., oral, DAP-VR and CAB-LA). From April 26 to 28, 2022, DREAMS staff utilized the REDCap mobile application to collect data. Data was analyzed in STATAv15.
RESULTS: Of the 1,656 respondents, 92% heard about PrEP for HIV prevention, and the primary sources of information were DREAMS staff (85%). Of these, 79% believed PrEP could reduce new HIV infection, and 68% knew PrEP could not prevent other STIs. Moreover, 97% knew where to get oral PrEP, 31% were current/previous users of oral PrEP, and 41% agreed/strongly agreed that PrEP has serious side effects.
Oral PrEP was well known to AGYW (85%), while 3% and 8% were aware of DVR and CAB-LA, respectively. If all three PrEP options are available, 83% (n=1262) of AGYW were willing to use any of them. Of these, 61% indicated a preference for CAB-LA, while 27% and 12% preferred oral and DVR. HIV prevention efficacy was a strong determinant of stated reason, followed by the desire for less frequent use and discreteness of the option.
CONCLUSIONS: The results from this study provide vital information for the successful introduction, scale-up, and continued use in the target population. CAB-LA injectable is the preferred PrEP option among AGYW mainly due to its efficacy, every eight-week administration instead of a daily pill, and its discreteness.