How effective is effective enough? Opinions of potential end-users of microbicides from a rural South African community

Abstract

To assess the views of potential end-users of a microbicide in KwaZulu-Natal regarding the characteristics that would justify further development, three focus group discussions were conducted in 2009 with 23 local staff members working on a microbicide clinical trial, 20 former trial participants and 14 Community Advisory Board members not enrolled in the trial, in an area with high HIV incidence and low consistent condom use. All participants agreed on the need for additional HIV prevention options that are as effective as possible and can be used by women. The majority of respondents stated that even a highly acceptable HIV prevention option with protection as low as 30% would still be an important addition to condoms for women; that a partially protective microbicide would have to be introduced as part of the existing prevention messages in order to continue promoting condom use; that there should eventually be a choice between antiretroviral (ARV) and non-ARV-based microbicides and a choice of how and where to access microbicides. Respondents also felt it would be important to make plans for access to a microbicide that can offer protection, even if partial, rather than wait to find out if alternative microbicides are equally or more effective. Potential end-users in a high HIV prevalence area believe that a partially effective microbicide would be an important addition to the limited HIV prevention options for women. The significant challenges of introducing a partially protective HIV prevention option were recognised, but seen as ones worth facing, as well as an opportunity to lay the ground work for the introduction of more efficacious HIV prevention methods in the future.

Keywords:

• microbicides
• access
• HIV
• women
• South Africa

Acknowledgements

We are grateful to the people of the Umkhanyakude District for their support. We especially thank the MDP staff members, MDP 301 trial participants and Africa Centre Community Advisory Board members who provided information for this study and commented on the findings after analysis. A special thanks to Sizakele Suzaki, Cebile Mdluli, Nkosinathi Mhlongo and Nozipho Ngwenya for their assistance in conducting the focus group discussions. The MDP 301 clinical trial was sponsored by the UK Medical Research Council (MRC) and funded by the MRC and the UK Department for International Development (DFID). Nuala McGrath is supported by a Wellcome Trust fellowship (grant # WT083495MA). The Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa, is supported through grants from the Wellcome Trust (G0100137).