Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
RTI International, Women's Global Health Imperative, San Francisco, California, USA.
J Int AIDS Soc. 2018 Aug;21(8):e25170. doi: 10.1002/jia2.25170.
Implants are a new dosage form in development for HIV pre-exposure prophylaxis (PrEP) with potential for high adherence given that they are provider-administered and are intended for long-acting protection. Integrating end-user preference into early stage product development may further overcome challenges with future product uptake and adherence. Hence, we sought to optimize the design of a PrEP implant in early-stage development by gathering opinions about implant attributes from potential end-users in South Africa.
We conducted 14 focus group discussions (FGDs) with young women and men aged 18 to 24 in Cape Town and Soshanguve, South Africa, inviting participants into discussion as co-designers. FGDs were homogenous by gender and previous implant experience. During FGDs, we showed prototype devices and followed a semi-structured guide with questions on history of contraceptive implant use, preferences for physical characteristics of an implant, implant biodegradability, insertion process, participant-driven ideas for implant design, and social adoption considerations. FGDs were facilitated in English, isiXhosa, Tswana, isiZulu, or Tsonga, audio-recorded, transcribed into English, and qualitatively coded and analysed.
In this qualitative sample of 105 youth (68 women and 37 men), 58 participants were from Soshanguve and 47 from Cape Town, and 23% had previously used contraceptive implants. Participants expressed preferences for several implant design features; specifically, longer duration (≥6 months) was more important to most participants than the size or number of devices implanted. A majority preferred a flexible versus stiff implant to minimize palpability, thereby increasing discreetness and comfort. Nearly all participants favoured a biodegradable implant to avoid removal and thus reduce clinic visits. Concerns about the implant centred on its possible side effects and the "plastic" look of the prototype displayed for demonstration.
This study offers preliminary insights into an implant for HIV prevention that provides long-lasting protection may be well received among young South Africans. Additionally, flexibility, discreetness, and biodegradability may increase acceptability of the implant. Such end-user feedback is being incorporated into current implant designs in the hope of creating an effective long-acting PrEP product that is likely to achieve high uptake and adherence in target populations.
植入物是一种新的开发中的 HIV 暴露前预防（PrEP）剂型，由于其由提供者管理，旨在提供长效保护，因此具有高依从性的潜力。将最终用户的偏好纳入早期产品开发中，可能会进一步克服未来产品采用和依从性方面的挑战。因此，我们试图通过从南非的潜在最终用户那里收集有关植入物属性的意见，来优化早期开发中的 PrEP 植入物的设计。
我们在南非开普敦和索沙古夫的 18 至 24 岁的年轻女性和男性中进行了 14 次焦点小组讨论（FGD），邀请参与者作为共同设计者参与讨论。FGD 按照性别和以前的植入物使用经验进行分组。在 FGD 中，我们展示了原型设备，并遵循半结构化指南进行讨论，问题包括避孕植入物使用史、对植入物物理特性的偏好、植入物的生物降解性、插入过程、参与者驱动的植入物设计理念，以及社会接受度的考虑因素。FGD 以英语、伊西索萨语、茨瓦纳语、祖鲁语或聪加语进行，录音，翻译成英语，然后进行定性编码和分析。
在这个定性样本中，有 105 名青年（68 名女性和 37 名男性），其中 58 名来自索沙古夫，47 名来自开普敦，23%的人以前使用过避孕植入物。参与者对几种植入物设计特征表示出偏好；具体而言，大多数参与者更看重较长的持续时间（≥6 个月），而不是植入的装置的大小或数量。大多数参与者更喜欢柔软的植入物而不是坚硬的植入物，以最大限度地减少触感，从而增加隐蔽性和舒适性。几乎所有参与者都赞成使用可生物降解的植入物，以避免移除，从而减少就诊次数。对植入物的关注集中在其可能的副作用和展示的原型的“塑料”外观上。
这项研究初步探讨了一种可能在南非年轻人中受到欢迎的长效 HIV 预防植入物。此外，灵活性、隐蔽性和生物降解性可能会提高植入物的可接受性。这种最终用户的反馈正在被纳入当前的植入物设计中，希望能创造出一种有效的长效 PrEP 产品，很可能在目标人群中实现高采用率和高依从性。
