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Background: In sub-Saharan Africa, considerable HIV-burden exists amongst women. It is hoped that new anti-retroviral (ARV) based prevention technologies could decrease this burden, but this will depend on user behaviour. Uptake of new products could be improved if they protect against pregnancy or sexually transmitted infections (STI).
Methods: We use a discrete choice experiment to project the likely uptake (% of women that use a product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, injectable long-lasting ARV agents (4-12 weekly injection), and gel-based ARV products (with/without diaphragm) amongst adolescent and adult women, and how uptake could depend on whether the product protects against pregnancy or STI acquisition. For different product scenarios, and assuming baseline condom use of 50%, a simple model was used to determine how the uptake of different products could decrease an individual''s average HIV transmission risk.
Results: In adolescent women, analyses suggest there will be limited uptake (< 7% use) and impact (< 8% decrease in HIV transmission risk) of any new product unless they also provide pregnancy protection, which could triple the level of use and impact achieved by a product. Conversely, adult women have lower preference for these additional benefits, with moderate use (≤16% for each product) and impact (12-16% decrease) being projected if the products only protect against HIV-acquisition. In terms of product preference, both adult and adolescent women have highest preference for injectable ARVs, with oral PrEP having high preference if injectable ARVs are not available. The ring will also be used by adult women, with lower predicted use by adolescents. Gel-based products were popular with adolescent women if they provided pregnancy protection when no other products did. However, even in the most favourable scenario, where all five prevention products are available and provide pregnancy and STI protection, projections still suggest that >20% of women will remain unprotected and one-third of the baseline transmission risk will remain.
Conclusions: Incorporating multiple prevention components into new ARV-based prevention products could dramatically increase their uptake and impact in certain sub-groups. The development of multipurpose technologies could be important for tackling the heightened burden of HIV amongst women.