End-user research for the development of an implant to prevent unintended pregnancy and HIV prevention

Abstract

Background: The SCHIELD (Subcutaneous Contraceptive and HIV Implant Engineered for Long‐Acting Delivery) programme aims to develop a Multipurpose Prevention Technology (MPT) implant for HIV and pregnancy prevention. An assessment was undertaken to provide rapid implant attribute and acceptability feedback to the product development team from potential end‐users.

Methods: Twelve Focus Group Discussions (FGDs) were conducted with women aged 18 to 34 in Soshanguve, South Africa and Harare, Zimbabwe along with quantitative demographic and preference data collection with each participant. FGDs were stratified by contraceptive implant experience as well as parity and transactional sex. Frequencies were run on quantitative data and debriefing reports of FGDs were analysed to summarize emerging themes.

Results: 110 women (median age 24) were enrolled, and they overwhelmingly supported the idea of an MPT implant. Preferred duration varied by participant type and country. Women who engaged in transactional sex in Soshanguve and parous women at both sites favoured a longer lasting implant (3 years), whereas women who engaged in transactional sex in Harare and nulliparous women generally preferred shorter durations (≤2 years). Participants had mixed reactions to possible menstrual changes related to use of a hormonal contraceptive, citing impact on daily activities and economic considerations (e.g. ability to engage in transactional sex, cost of menstrual products). These were considered possible barriers to future uptake and persistence with an MPT implant. Participants anticipated situations where their desire to conceive could rapidly change, necessitating a quickly reversible contraceptive component, whereas the need for quick reversibility for the HIV prevention indication was not anticipated. This drove preference – especially in Harare – for separate rods for each indication, with easy removability of the contraceptive portion while the HIV prevention portion could be left in place (preference for separate rods: Harare = 70%, Soshanguve = 48%).

Conclusions: An MPT implant system for prevention of HIV and unintended pregnancy was highly desirable to potential end‐users, and optimal duration may vary by personal and country context. Furthermore, product developers should consider the importance of return to fertility and tolerance for menstrual changes in early stages of product development when it is more feasible to modify attributes of an MPT product containing a hormonal contraceptive.