by Siyanda Tenza, Lydia Mampuru, Mpho Moji, Sihle Zulu, Lorna Begg, Irene V Bruce, Krishnaveni Reddy, Barbara A Friedland, Thesla Palanee‑Phillips, Sanyukta Mathur
BMC Women’s Health 2024;24:462 https://doi.org/10.1186/s12905-024-03269-8 (Open access)
Abstract
Background: HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women
in Johannesburg, South Africa.
Methods: Between March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16–40 stratified by ages (16–17, 18–24, 25–40), half of whom were COC users. We explored adolescent girls and women’s opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis.
Results: The majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient “two-in-one” solution, requiring one clinic visit for both PrEP and COCs. Adolescent girls and young women were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers. Conclusions/significance The DPP was perceived as acceptable for HIV and pregnancy prevention to adolescent girls and young women in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence.
Conclusion: In this study, women seemed to report that the DPP is a potentially viable MPT option for women in Johannesburg that could improve PrEP uptake and provide another option for pregnancy protection. Implementation programs related to the DPP need to consider both product-related and nonproduct-related potential barriers to DPP uptake and use. DPP uptake will be supported by clear, accurate, and specific guidance on the product, broad-based awareness raising and community support, trusted and supportive care provision, and connections with women who have experience with the product. Additionally, interpersonal (partner perspectives) and social (parents/community perspectives) implications of use will need to be considered to ensure women are able to use this innovative product, once available.