Dada Siphokazi, Musvipwa Faith Mary, Cholo Fatima Abegail, Pleaner Melanie, Kutywayo Alison, Butler Vusile, Martin Catherine Elizabeth, Mullick Saiqa
Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2025 Jul;28 Suppl 2(Suppl 2):e26462. doi: 10.1002/jia2.26462.
Long-acting injectable cabotegravir and dapivirine vaginal ring were recently introduced in South Africa through demonstration projects, providing additional HIV prevention options to oral pre-exposure prophylaxis (PrEP). PrEP choice marks a pivotal moment in HIV prevention, potentially increasing PrEP uptake and use by offering women a choice of methods best suited to their individual needs. Understanding experiences of PrEP choice in real-world settings is critical to informing the introduction of PrEP choice at scale. This study, embedded within an implementation science study introducing new PrEP methods, explores women's experiences of PrEP choice counselling, and factors influencing PrEP choice.
Between April and May 2024, we conducted 12 focus group discussions with a sub-set of 126 women (18-57 years) enrolled in a parent cohort study delivering PrEP choice at six fixed and three roving mobile clinics in three areas of South Africa. Cohort participants are HIV-negative men and women ≥ 15 years interested in HIV prevention services. At the time of data collection, non-pregnant and lactating women ≥ 18 years enrolled in the cohort were provided PrEP choice counselling and offered a choice of oral PrEP or dapivirine vaginal ring. Discussions explored women's experiences of PrEP choice counselling and influences of PrEP choice. They were audio recorded, transcribed verbatim and translated into English for thematic analysis.
Women reported positive choice counselling experiences, particularly when it was supplemented by pamphlets, demonstration rings and pelvic models. Participants valued learning about alternative PrEP methods and appreciated friendly healthcare providers who answered their questions. Privacy and emotional support were also crucial. However, negative experiences included the use of complex scientific jargon and insufficient information on PrEP's potential drawbacks. PrEP choices were mainly influenced by concerns about intravaginal products, distrust of new methods, prior oral PrEP experiences, and partner and family opinions.
These findings will guide strategies for PrEP delivery, emphasizing provider training, effective counselling tools and tailored communication. Women valued clear, jargon-free information, visual aids and a welcoming environment, which supported open dialogue. The influence of prior oral PrEP experiences on PrEP choice highlights the need for counselling that addresses specific concerns and preferences.
长效注射用卡博特韦和达匹韦林阴道环最近通过示范项目引入南非，为口服暴露前预防（PrEP）提供了更多的艾滋病毒预防选择。PrEP选择标志着艾滋病毒预防的一个关键时刻，通过为女性提供最适合其个人需求的方法选择，可能会增加PrEP的接受率和使用率。了解现实环境中PrEP选择的经历对于大规模引入PrEP选择至关重要。本研究嵌入一项引入新PrEP方法的实施科学研究中，探讨了女性在PrEP选择咨询方面的经历以及影响PrEP选择的因素。
2024年4月至5月期间，我们对126名年龄在18 - 57岁的女性进行了12次焦点小组讨论，这些女性是参与一项在南非三个地区的六个固定诊所和三个巡回移动诊所提供PrEP选择的母队列研究的子样本。队列参与者是年龄≥15岁、对艾滋病毒预防服务感兴趣的艾滋病毒阴性男性和女性。在数据收集时，队列中年龄≥18岁的非怀孕和哺乳期女性接受了PrEP选择咨询，并被提供口服PrEP或达匹韦林阴道环的选择。讨论探讨了女性在PrEP选择咨询方面的经历以及PrEP选择的影响因素。讨论进行了录音，逐字转录并翻译成英文进行主题分析。
女性报告了积极的选择咨询经历，特别是当有宣传册、示范环和盆腔模型辅助时。参与者重视了解替代PrEP方法，并赞赏能回答她们问题的友好医疗服务提供者。隐私和情感支持也很关键。然而，负面经历包括使用复杂的科学术语以及关于PrEP潜在缺点的信息不足。PrEP选择主要受到对阴道内产品的担忧、对新方法的不信任、先前口服PrEP的经历以及伴侣和家人意见的影响。
这些发现将指导PrEP提供的策略，强调提供者培训、有效的咨询工具和针对性的沟通。女性重视清晰、无行话的信息、视觉辅助工具和友好的环境，这有助于进行开放的对话。先前口服PrEP的经历对PrEP选择的影响凸显了针对特定担忧和偏好进行咨询的必要性。
