Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK (MQ, RE, PV, FT).
Wits RHI, University of the Witwatersrand, Johannesburg, Gauteng, South Africa (MQ, RE, EAC, SD).
Med Decis Making. 2018 Jan;38(1):120-133. doi: 10.1177/0272989X17729376. Epub 2017 Sep 1.
BACKGROUND: The development of antiretroviral (ARV)-based prevention products has the potential to substantially change the HIV prevention landscape; yet, little is known about how appealing these products will be outside of clinical trials, as compared with the existing options. METHODS: We conducted a discrete choice experiment (DCE) to measure preferences for 5 new products among 4 important populations in the HIV response: adult men and women in the general population (aged 18 to 49 y), adolescent girls (aged 16 to 17 y), and self-identifying female sex workers (aged 18 to 49 y). We interviewed 661 self-reported HIV-negative participants in peri-urban South Africa, who were asked to choose between 3 unique, hypothetical products over 10 choice sets. Data were analyzed using multinomial, latent class and mixed multinomial logit models. RESULTS: HIV protection was the most important attribute to respondents; however, results indicate significant demand among all groups for multipurpose prevention products that offer protection from HIV infection, other STIs, and unwanted pregnancy. All groups demonstrated a strong preference for long-lasting injectable products. There was substantial heterogeneity in preferences within and across population groups. LIMITATIONS: Hypothetical DCE data may not mirror real-world choices, and products will have more attributes in reality than represented in choice tasks. Background data on participants, including sensitive areas of HIV status and condom use, was self-reported. CONCLUSIONS: These results suggest that stimulating demand for new HIV prevention products may require a more a nuanced approach than simply developing highly effective products. No single product is likely to be equally attractive or acceptable across different groups. This study strengthens the call for effective and attractive multipurpose prevention products to be deployed as part of a comprehensive combination prevention strategy.
背景:基于抗逆转录病毒(ARV)的预防产品的开发有可能极大地改变 HIV 预防格局;然而,与现有选择相比,对于这些产品在临床试验之外的吸引力,人们知之甚少。
方法:我们进行了一项离散选择实验(DCE),以衡量 HIV 应对中 4 个重要人群(18 至 49 岁的成年男女、16 至 17 岁的少女和自我认同的女性性工作者)对 5 种新的产品的偏好。我们采访了南非城市周边地区的 661 名自我报告的 HIV 阴性参与者,他们被要求在 10 个选择集中选择 3 种独特的假设产品。使用多项、潜在类别和混合多项逻辑回归模型对数据进行分析。
结果:HIV 保护是受访者最重要的属性;然而,结果表明,所有群体对提供 HIV 感染、其他性传播感染和意外怀孕保护的多用途预防产品都有很大的需求。所有群体都强烈偏好长效注射产品。人群内部和人群之间的偏好存在很大的异质性。
局限性:假设的 DCE 数据可能无法反映现实世界的选择,而且产品在现实中会有比选择任务中更多的属性。参与者的背景数据,包括 HIV 状况和避孕套使用的敏感领域,是自我报告的。
结论:这些结果表明,刺激对新的 HIV 预防产品的需求可能需要比仅仅开发高度有效的产品更细致入微的方法。没有一种产品在不同群体中可能同样具有吸引力或可接受性。这项研究加强了呼吁部署有效和有吸引力的多用途预防产品作为综合综合预防策略的一部分。
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