Perspectives of South African youth in the development of an implant for HIV prevention
Perspectives of South African youth in the development of an implant for HIV prevention
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DOI：
10.1002/jia2.25170
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发表时间：
2018-08-27
影响因子：
6
通讯作者：
van der Straten, Ariane
中科院分区：
文献类型：
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作者：
Krogstad, Emily A.;Atujuna, Millicent;van der Straten, Ariane
简介：植入物是一种正在开发的新剂型，用于HIV暴露前预防(PrEP)，具有高依从性的潜力，因为它们是由提供者管理的，旨在提供长效保护。将终端用户的偏好整合到早期产品开发中，可能会进一步克服未来产品吸收和坚持方面的挑战。因此，我们试图通过收集南非潜在最终用户对植入物属性的意见，在早期开发阶段优化PrEP植入物的设计。方法：我们在南非开普敦和Soshanguve与18至24岁的年轻女性和男性进行了14次焦点小组讨论(FGD)，邀请参与者作为联合设计师进行讨论。FGD在性别和既往植入经验上是同质性的。在FGDS期间，我们展示了原型设备，并遵循了半结构化指南，其中包括避孕植入物使用史、对植入物物理特征的偏好、植入物的生物降解性、植入过程、参与者驱动的植入物设计想法以及社会采用考虑因素等问题。结果：在105名青年(68名女性和37名男性)的定性样本中，58名来自Soshanguve，47名来自开普敦，23%的人以前使用过避孕药。参与者表达了对几种植入物设计特征的偏好；具体地说，对大多数参与者来说，更长的持续时间(=6个月)比植入物的大小或数量更重要。大多数人更喜欢柔韧的植入物，而不是僵硬的植入物，以最大限度地减少触觉，从而增加谨慎和舒适性。几乎所有参与者都倾向于使用可生物降解的植入物，以避免移除，从而减少就诊次数。人们对植入物的担忧集中在其可能的副作用和展示的原型的“塑料”外观上。结论：这项研究为预防艾滋病毒的植入物提供了初步的见解，提供了长期的保护，可能会受到南非年轻人的欢迎。此外，灵活性、保密性和生物降解性可能会增加植入物的可接受性。这样的终端用户反馈正在被纳入目前的植入物设计，希望创造出一种有效的长效PrEP产品，很可能在目标人群中实现高吸收率和依从性。
Introduction: Implants are a new dosage form in development for HIV pre-exposure prophylaxis (PrEP) with potential for high adherence given that they are provider-administered and are intended for long-acting protection. Integrating end-user preference into early stage product development may further overcome challenges with future product uptake and adherence. Hence, we sought to optimize the design of a PrEP implant in early-stage development by gathering opinions about implant attributes from potential end-users in South Africa.Methods: We conducted 14 focus group discussions (FGDs) with young women and men aged 18 to 24 in Cape Town and Soshanguve, South Africa, inviting participants into discussion as co-designers. FGDs were homogenous by gender and previous implant experience. During FGDs, we showed prototype devices and followed a semi-structured guide with questions on history of contraceptive implant use, preferences for physical characteristics of an implant, implant biodegradability, insertion process, participant-driven ideas for implant design, and social adoption considerations. FGDs were facilitated in English, isiX-hosa, Tswana, isiZulu, or Tsonga, audio-recorded, transcribed into English, and qualitatively coded and analysed.Results: In this qualitative sample of 105 youth (68 women and 37 men), 58 participants were from Soshanguve and 47 from Cape Town, and 23% had previously used contraceptive implants. Participants expressed preferences for several implant design features; specifically, longer duration (>= 6 months) was more important to most participants than the size or number of devices implanted. A majority preferred a flexible versus stiff implant to minimize palpability, thereby increasing discreetness and comfort. Nearly all participants favoured a biodegradable implant to avoid removal and thus reduce clinic visits. Concerns about the implant centred on its possible side effects and the "plastic" look of the prototype displayed for demonstration.Conclusions: This study offers preliminary insights into an implant for HIV prevention that provides long-lasting protection may be well received among young South Africans. Additionally, flexibility, discreetness, and biodegradability may increase acceptability of the implant. Such end-user feedback is being incorporated into current implant designs in the hope of creating an effective long-acting PrEP product that is likely to achieve high uptake and adherence in target populations.