Makoni Wanzirai, Lorenzetti Lara, Mancuso Noah, Luecke Ellen, Dinh Nhi, Deshpande Ashwini S, Shoen Marie, Nhamo Definate, Simmonds Francis M, Baez Alejandro, Palanee-Phillips Thesla, Minnis Alexandra M
Pangaea Zimbabwe, Harare, Zimbabwe.
FHI 360, Durham, NC, USA.
AIDS Behav. 2025 Jan;29(1):257-293. doi: 10.1007/s10461-024-04529-2. Epub 2024 Oct 18.
The availability of several HIV prevention options may allow women to choose a product that suits their lifestyle and preferences. Product attributes and contextual factors influence product acceptability, which affects uptake and effective use. We conducted a systematic review of acceptability and preference for biomedical HIV prevention products among women in sub-Saharan Africa (SSA) to inform the development of novel products. We used a comprehensive strategy to search three databases for peer-reviewed literature from SSA published between January 2015 and December 2023. A two-stage review process assessed references against eligibility criteria. Data were abstracted using a standardized spreadsheet, then organized by constructs from two theoretical frameworks of acceptability. Results were synthesized based on product classes defined by route of administration. We identified 408 unique references; 100 references met eligibility criteria. References assessed oral PrEP (n = 65), vaginal ring (n = 44), long-acting systemic products (injectable, implant, microarray patch) (n = 28), and other vaginal products (film, insert, gel) (n = 20). Over two-thirds reported qualitative or mixed-methods data, primarily from adolescent girls and young women. Frequent dosing, especially noted for daily oral PrEP, and perceived/experienced side effects were notably negative influences. Most end-users preferred long-acting products (systemically or vaginally delivered), though on-demand products offering user control were also valued. Influencing factors, especially partners, shaped end-user perceptions of product attributes and acceptability. All products were linked to at least some barriers to uptake and/or use, highlighting the need to provide end-users with a range of options and assist them in identifying one that best suits their circumstances and needs. Biomedical HIV prevention development should advance products that address gaps in available options while optimizing favorable product attributes to achieve high acceptability that ultimately supports adoption and use.
多种HIV预防产品可供选择，这可能使女性能够选择适合其生活方式和偏好的产品。产品属性和背景因素会影响产品的可接受性，进而影响其采用和有效使用。我们对撒哈拉以南非洲（SSA）女性对生物医学HIV预防产品的可接受性和偏好进行了系统综述，以为新产品的开发提供参考。我们采用了全面的策略，在三个数据库中搜索2015年1月至2023年12月期间发表的来自SSA的同行评审文献。一个两阶段的评审过程根据入选标准评估参考文献。使用标准化电子表格提取数据，然后根据两个可接受性理论框架的构建进行整理。结果根据给药途径定义的产品类别进行综合。我们识别出408篇独特的参考文献；100篇参考文献符合入选标准。参考文献评估了口服暴露前预防（PrEP）（n = 65）、阴道环（n = 44）、长效全身产品（注射剂、植入剂、微阵列贴片）（n = 28）和其他阴道产品（薄膜、插入剂、凝胶）（n = 20）。超过三分之二的文献报告了定性或混合方法数据，主要来自青少年女孩和年轻女性。频繁给药，尤其是每日口服PrEP，以及感知到的/经历过的副作用是明显的负面影响。大多数最终用户更喜欢长效产品（全身或阴道给药），不过提供用户控制权的按需产品也受到重视。影响因素，尤其是伴侣，塑造了最终用户对产品属性和可接受性的认知。所有产品都与至少一些采用和/或使用障碍相关联，这凸显了为最终用户提供一系列选择并帮助他们确定最适合其情况和需求的产品的必要性。生物医学HIV预防的发展应推进能够弥补现有选择差距的产品，同时优化有利的产品属性，以实现高可接受性，最终支持产品的采用和使用。
