Mathur Sanyukta, Plagianos Marlena, Friedland Barbara, Bruce Irene, Burnett-Zieman Brady, Dandazi Adlight, Musara Petina, Ndlovu Nkosiphile, Sedze Natasha, Tenza Siyanda, Reddy Krishnaveni, Zulu Shile, Haddad Lisa, Murombedzi Caroline, Mgodi Nyaradzo, Palanee-Philips Thesla
Population Council.
University of Zimbabwe.
Res Sq. 2025 Jun 9:rs.3.rs-6683281. doi: 10.21203/rs.3.rs-6683281/v1.
A dual prevention pill (DPP) for co-delivery of pregnancy and HIV prevention is currently in development and will offer an alternative to taking two separate products. We examined behavioral, partnership/interpersonal, social, and structural correlates of preferences for an over-encapsulated DPP (as a proxy for the product in development, consisting of oral contraceptive pill and oral PrEP pill) among women and adolescent girls in South Africa and Zimbabwe to inform DPP introduction and counseling strategies.
This secondary analysis used data from two clinical crossover studies that compared the acceptability, adherence, and preference for the over-encapsulated DPP versus separate PrEP and oral contraceptives. HIV-uninfected, non-pregnant cisgender women were enrolled in Johannesburg, South Africa (n = 96, ages 18-40) and Harare, Zimbabwe (n = 30, ages 16-24). Participants were randomized 1:1 to use either DPP or two separate pills for three 28-day cycles, then switched. Preferences were measured at the end of crossover and via exit in-depth interviews.
The mean age was 27 years in South Africa and 19 years for Zimbabwe. Most participants had completed secondary school. Childbearing was more common in Zimbabwe (97%) than South Africa (74%). Pregnancy prevention was highly valued in both sites (~ 90%), but Zimbabwean participants voiced greater concern about HIV. DPP preference was higher in Zimbabwe (62%) than South African (39%). In South Africa, DPP preference was associated with behavioral factors (anal sex, experience of sexual violence, relationship conflict, and transactional relationships/sex) and product characteristics (ease of use, side effects). In Zimbabwe, concern about HIV acquisition, interpersonal power, and structural factors (i.e., food insecurity and housing security) were associated with DPP preference. Qualitative interviews highlighted the DPP's simplicity as key advantage over two separate pills, though participants desired a smaller DPP and more discreet packaging to reduced stigma and ease use.
While women in both countries value integrated HIV and pregnancy prevention, distinct demographic, behavioral, and social factors influence DPP preference. Tailoring DPP introduction and support strategies to address specific challenges-such as relationship dynamics and product usability-may optimize the acceptance and effectiveness of dual prevention strategies.
一种用于同时预防怀孕和艾滋病毒的双效预防药丸（DPP）目前正在研发中，它将为服用两种单独产品提供一种替代方案。我们研究了南非和津巴布韦的妇女及少女对超封装DPP（作为正在研发产品的替代物，由口服避孕药丸和口服暴露前预防药丸组成）偏好的行为、伴侣关系/人际关系、社会和结构相关因素，以为DPP的引入和咨询策略提供参考。
这项二次分析使用了两项临床交叉研究的数据，该研究比较了超封装DPP与单独的暴露前预防药物和口服避孕药的可接受性、依从性和偏好。未感染艾滋病毒、未怀孕的顺性别女性在南非约翰内斯堡（n = 96，年龄18 - 40岁）和津巴布韦哈拉雷（n = 30，年龄16 - 24岁）入组。参与者被随机分为1:1，使用DPP或两种单独的药丸，为期三个28天周期，然后进行切换。在交叉结束时和通过退出深度访谈来测量偏好。
南非参与者的平均年龄为27岁，津巴布韦为19岁。大多数参与者完成了中学学业。生育在津巴布韦（97%）比南非（74%）更常见。在两个地点，预防怀孕都受到高度重视（约90%），但津巴布韦的参与者对艾滋病毒更为担忧。津巴布韦（62%）对DPP的偏好高于南非（39%）。在南非，对DPP的偏好与行为因素（肛交、性暴力经历、关系冲突以及交易性关系/性行为）和产品特性（易用性、副作用）有关。在津巴布韦，对感染艾滋病毒的担忧、人际权力和结构因素（即粮食不安全和住房安全）与对DPP的偏好有关。定性访谈强调了DPP的简单性是相对于两种单独药丸的关键优势，不过参与者希望DPP更小且包装更隐蔽，以减少污名并便于使用。
虽然两国的女性都重视综合的艾滋病毒和怀孕预防，但不同的人口统计学、行为和社会因素会影响对DPP的偏好。针对特定挑战（如关系动态和产品可用性）调整DPP的引入和支持策略，可能会优化双重预防策略的接受度和有效性。
