title: The importance of choice in the rollout of ARV-based prevention to user groups in Kenya and South Africa: a qualitative study.
abstract: BACKGROUND
  Stakeholders continue to discuss the appropriateness of antiretroviral-based pre-exposure prophylaxis (PrEP) for HIV prevention among sub-Saharan African and other women. In particular, women need formulations they can adhere to given that effectiveness has been found to correlate with adherence. Evidence from family planning shows that contraceptive use, continuation and adherence may be increased by expanding choices. To explore the potential role of choice in women's use of HIV prevention methods, we conducted a secondary analysis of research with female sex workers (FSWs) and men and women in serodiscordant couples (SDCs) in Kenya, and adolescent and young women in South Africa. Our objective here is to present their interest in and preferences for PrEP formulations - pills, gel and injectable.
  
  
  METHODS
  In this qualitative study, in Kenya we conducted three focus groups with FSWs, and three with SDCs. In South Africa, we conducted two focus groups with adolescent girls, and two with young women. All focus groups were audio-recorded, transcribed and translated into English as needed. We structurally and thematically coded transcripts using a codebook and QSR NVivo 9.0; generated code reports; and conducted inductive thematic analysis to identify major trends and themes.
  
  
  RESULTS
  All groups expressed strong interest in PrEP products. In Kenya, FSWs said the products might help them earn more money, because they would feel safer accepting more clients or having sex without condoms for a higher price. SDCs said the products might replace condoms and reanimate couples' sex lives. Most sex workers and SDCs preferred an injectable because it would last longer, required little intervention and was private. In South Africa, adolescent girls believed it would be possible to obtain the products more privately than condoms. Young women were excited about PrEP but concerned about interactions with alcohol and drug use, which often precede sex. Adolescents did not prefer a particular formulation but noted benefits and limitations of each; young women's preferences also varied.
  
  
  CONCLUSIONS
  The circumstances and preferences of sub-Saharan African women are likely to vary within and across groups and to change over time, highlighting the importance of choice in HIV prevention methods.
authors.affiliation: Social and Behavioral Health Sciences, FHI 360, Durham, NC, USA; nmack@fhi360.org.
authors.forename: Natasha
authors.initials: N
authors.lastname: Mack
authors.affiliation: Health Services Research, FHI 360, Durham, NC, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Evens
authors.affiliation: Social and Behavioral Health Sciences, FHI 360, Durham, NC, USA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Tolley
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Brelsford
authors.affiliation: Applied Research Unit, FHI 360, Nairobi, Kenya.
authors.forename: Caroline
authors.initials: C
authors.lastname: Mackenzie
authors.affiliation: MatCH (Maternal, Adolescent and Child Health), Durban, South Africa.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Milford
authors.affiliation: MatCH (Maternal, Adolescent and Child Health), Durban, South Africa.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Smit
authors.affiliation: Kenya AIDS Control Project, Nairobi, Kenya.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kimani
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007630:Kenya; D008297:Male; D010342:Patient Acceptance of Health Care; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D013019:South Africa; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: ARV-based HIV prevention methods; HIV prevention; pre-exposure prophylaxis; sub-Saharan Africa; women