van der Straten A, Cheng H, Agot K, Ahmed K, Weinrib R, Manenzhe K, Owino F, Minnis A. Preference and choice of multipurpose prevention technologies in young African women. Poster presented at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI); February 13, 2017. Seattle, WA.

Preventing HIV and unintended pregnancies are key health priorities in young African women. We evaluated product preference and choice in a cross-over study of 3 multipurpose prevention technology (MPT) placebo delivery forms: vaginal ring, injections or daily pills. We enrolled 277 HIV-negative, sexually active, non-pregnant women aged 18-30 in a randomized cross-over study to use each MPT for one month. Participants were provided male condoms at every visit. Participants ranked the 3 products and condoms (from #1 top to #4 bottom), at enrollment and month-3. Next they chose one MPT for an additional 2-month usage period. We examined changes in product ranking between enrollment and month-3 (Wilcoxon signed-rank test), and, in multivariable logistic regression, the relationships of age (<25 vs. 25+) and country with the product ranked #1 at month-3, adjusting for past use of the contraceptive delivery form. Among the 214 participants who have reached their month-3 visit, 109 are from Kenya (51%) and 105 from South Africa, mean age is 23.2 years and 94% currently have a main partner. Product ranking significantly increased between enrollment and month-3 for injections (p<.001) and for ring (p<.001), but decreased for pills (p<.0001) and condoms (p=0.02). At month-3, 63% top-ranked injections, 16% top-ranked pills, 12% top-ranked ring and 9% top-ranked condoms (Figure 1). Age or country were not associated with top-ranking injection or ring at month-3; however, more Kenyans ranked pills as their #1 preference (AOR=2.3, 95% CI 1.1-5.1), compared to South Africans. MPT choice for the usage period mimicked preference ranking: 64% chose injections, 22% chose pills and 14% chose ring. 'Ease of use' was the most common reason for choosing any of the three MPT; for injections or ring, infrequent dosing was another common reason, while lack of side effects was cited for pills. Compared to male condoms, an existing MPT, all Trio products ranked similarly or higher. Injections were the top preference for a majority, while pills and rings each were most preferred by fewer than 1 in 5 participants, with some variation by country. MPT ranking changed following actual experience with each product, and it aligned well with product choice. User convenience appeared as paramount for selecting an MPT.

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