Background
PURPOSE 1 demonstrated 100% efficacy of twice-yearly injectable lenacapavir (LEN) for HIV pre-exposure prophylaxis (PrEP) in cisgender adolescent girls and young women. We conducted a nested qualitative sub-study exploring acceptability, preferences, and experiences with LEN and daily oral emtricitabine plus tenofovir alafenamide (F/TAF) or tenofovir disoproxil fumarate (F/TDF) for PrEP during the randomized blinded phase.
Methods
In-depth interviews (IDIs) were conducted at 5 geographically diverse South African trial sites, with: a) a randomly selected subset of participants aged 18–25 years at Weeks 13 and 52; b) purposively selected participants aged 16–17 years at Weeks 26 and 52; and c) participants aged 16–25 years who discontinued PrEP, were pregnant or breastfeeding (P/BF), or acquired HIV. IDIs were administered in English and/or local languages. Data were coded in Dedoose™, analyzed thematically, and summarized. Analyses were restricted to IDIs captured before PURPOSE 1 interim results.
Results
Data from 108 participants (including: n=25 aged 16–17 years; n=16 discontinued; n=13 P/BF; n=8 acquired HIV) are described. LEN injections and both oral regimens were widely perceived as helpful and protective. Participants appreciated injections for their “once-off” 6-month activity and the potential implication of a worry-free HIV protection period, without taking daily tablets, barriers of concealing medication, or being judged for their use. Some participants reported injection-related concerns about “lumps” or pain that generally resolved within 1–2 days and was mitigated by analgesics. However, participants often felt that the benefits of duration of protection outweighed the often short-lived discomfort of injection receipt. Daily pill use was frequently reported to be difficult, “boring,” forgettable, and incompatible with lifestyles. Participants, particularly those aged 16–17 years, noted that injections suited their lifestyles, as they are “multitasking” and “juggling” along with “going out” and having “nice times,” making pill use inconvenient. Participants appreciated the smaller F/TAF (vs F/TDF) tablets and comparative ease in swallowing.
Conclusions
PURPOSE 1 participants valued sustained protection from HIV, often preferred the lifestyle fit of a twice-yearly injectable vs daily oral PrEP, and accepted pain and injection-site reactions. These data suggest acceptability and preference for twice-yearly injections and/or F/TAF, reinforcing the value of product choice.