Abstract
Purpose
Unintended pregnancy and HIV infection present dual risks for young women in sub-Saharan Africa. New multipurpose prevention technologies (MPTs) are in development to simultaneously prevent unintended pregnancy and HIV, but there is a need for end-user research to ensure these products suit women’s needs. The Tablet, Rings and Injectables as Options (TRIO) for women study took place in Kisumu, Kenya, and Soshanguve, South Africa, with the goal of eliciting young women’s feedback on three potential MPTs.
Methods
Women in TRIO used three placebo products that represented potential MPTs: daily oral tablets, monthly vaginal rings, and monthly dual injections in a randomized crossover design followed by a period in which they chose a product to use. Eighty-eight TRIO participants completed in-depth interviews and focus group discussions to understand their experiences using each product. Qualitative analyses were conducted after stratifying by product preference at the end of the crossover period.
Results
The majority (65%) of participants preferred injections, with the remainder evenly split between tablets and rings. Discussions of preference for one product were closely linked with expressed dislike of another product’s attributes. Participants recognized heterogeneity in preferences and choices across users and stressed the need for multiple MPT options that confer a low burden on women’s daily lives.
Conclusion
Rather than choosing a product to use based on the product’s perceived advantages, women’s choices were based on the unfavorable attributes of other TRIO products. Moreover, the importance that women placed on a given disadvantage varied. Disadvantages that women deemed as most important emerged as a greater driver of product preference than selecting products based on their advantages and favorable characteristics.
Acknowledgments
The authors would like to express deep gratitude to all the TRIO study participants, and the critical work done by the TRIO study staff at IRDO (Jacob Onyango, Millicent Oswe, Lillian Akoth Ouma, Nancy Oyugi, Ezinah Kemunto, Roselyne Aluoch, Olivia Atieno Okumu, Philip Owiti Odote, Florence Sijenje, Frederick Owino, Timothy Okello), SRC (Dr Khatija Ahmed, Lebogang Letta Mpete, Thulisile Enough Mbatsane, Tsholofelo Engla Malapane), and RTI (Rachel Weinrib, Erica Browne, Danielle Wagner, Jonah Leslie, Shannon O’Rourke). Many thanks also to Megan Comfort for her careful review of this manuscript. Funding for this study was supported by the Bill & Melinda Gates Foundation (OPP1114942). Writing of this manuscript was funded in part by internal funds from RTI International.
Disclosure
The authors report no conflicts of interest in this work.