Implants for HIV prevention in young women: Provider perceptions and lessons learned from contraceptive implant provision

PLoS One. 2022 Jan 13;17(1):e0262043. doi: 10.1371/journal.pone.0262043. eCollection 2022.

Abstract

Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic especially in sub-Saharan Africa. Potent antiretroviral (ARV) drugs used as pre-exposure prophylaxis (PrEP) are currently being formulated as long-acting implantable devices, or nanosuspension injectables that release drug at a sustained rate providing protection from acquiring HIV. PrEP as implants (PrEP Implants) offers an innovative and novel approach, expanding the HIV prevention toolbox. Feedback from providers and future users in the early clinical product development stages may identify modifiable characteristics which can improve acceptability and uptake of new technologies. Healthcare workers (HCWs) perspectives and lessons learned during the rollout of contraceptive implants will allow us to understand what factors may impact the roll-out of PrEP implants. We conducted eighteen interviews with HCWs (9 Nurses and 9 Community Healthcare Workers) in rural KwaZulu-Natal, South Africa. HCWs listed the long-acting nature of the contraceptive implant as a key benefit, helping to overcome healthcare system barriers like heavy workloads and understaffing. However, challenges like side effects, migration of the implant, stakeholder buy-in and inconsistent training on insertion and removal hampered the roll-out of the contraceptive implant. For PrEP implants, HCWs preferred long-acting products that were palpable and biodegradable. Our findings highlighted that the characteristics of PrEP implants that are perceived to be beneficial by HCWs may not align with that of potential users, potentially impacting the acceptability and uptake of PrEP implants. Further our data highlight the need for sustained and multi-pronged approaches to training HCWs and introducing new health technologies into communities. Finding a balance between the needs of HCWs that accommodate their heavy workloads, limited resources at points of delivery of care and the needs and preferences of potential users need to be carefully considered in the development of PrEP implants.

MeSH terms

  • Absorbable Implants
  • Adult
  • Anti-Retroviral Agents / administration & dosage
  • Contraception / adverse effects
  • Contraception / methods*
  • Contraceptive Agents, Hormonal / administration & dosage
  • Desogestrel / administration & dosage
  • Drug Implants
  • Female
  • HIV Infections / prevention & control*
  • Health Personnel / psychology*
  • Humans
  • Interviews as Topic
  • Middle Aged
  • Perception*
  • Pre-Exposure Prophylaxis / methods*
  • Rural Population
  • South Africa

Substances

  • Anti-Retroviral Agents
  • Contraceptive Agents, Hormonal
  • Drug Implants
  • etonogestrel
  • Desogestrel

Grant support

Funding: Funding for the study was provided by South African Medical Research Council Special initiative grant (00251), and partial support from the Department of Science and Innovation-National Research Foundation Centre of Excellence in HIV Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.