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Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment

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Abstract

Female sex workers (FSW) in Malawi have among the highest HIV prevalence estimates worldwide. Daily oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet preferences for PrEP delivery among FSW are lacking. Eight focus group discussions, a literature review, and cognitive interviews were conducted to identify modifiable PrEP delivery attributes and inform discrete-choice experiment (DCE) development for FSW in Lilongwe. Enrolled FSW received an interviewer-assisted DCE. Data were analyzed using mixed logit regression. Dispensing location was most preferred, followed by the provision of additional services. Women preferred receiving PrEP at family planning clinics or non-governmental organization run drop-in centers. Cervical cancer screening was the most preferred additional service, while pregnancy testing and partner risk reduction counseling were less valued. This study was the first study to examine PrEP delivery preferences in Malawi using DCE—a powerful elicitation tool to apply to other key populations at risk for HIV.

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Acknowledgements

We would like to acknowledge Dylane Davis, Emmanuel Zalira, the Family Planning Association of Malawi, and UNC Project Malawi for their contributions and support to this project. We are also grateful to the participants who courageously shared their time, thoughts, and stories. This work was supported by the University of North Carolina at Chapel Hill Center for AIDS Research, an NIH funded program (P30 AI50410).

Funding

This work was supported by the University of North Carolina at Chapel Hill Center for AIDS Research, an NIH funded program (P30 AI50410).

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Author notes

  1. Kathryn E. Lancaster and Thandie Lungu have contributed equally to the work.

Authors and Affiliations

  1. Division of Epidemiology, College of Public Health, The Ohio State University, 334 Cunz Hall, 1841 Neil Ave, Columbus, OH, USA

    Kathryn E. Lancaster & William C. Miller

  2. University of North Carolina Project-Malawi, Lilongwe, Malawi

    Thandie Lungu, Agatha Bula & Mina C. Hosseinipour

  3. Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Jaclyn M. Shea, Vivian F. Go & Carol E. Golin

  4. Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA

    Abigail Shoben

  5. Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Mina C. Hosseinipour, Irving F. Hoffman & Carol E. Golin

  6. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Racquel E. Kohler

  7. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Stephanie B. Wheeler

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  1. Kathryn E. Lancaster
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Contributions

KEL and TL had overall responsibility for implementing the study, and conceived and designed the study, analyzed the data, and led the manuscript writing. KEL, TL, MCH, VFG, CEG, SBW, and WCM contributed to developing the study concept and design. TL, AG, and JS contributed to data collection. JS, AS, and REK assisted with data analysis and results interpretation. JS, AS, MCH, REK, IFH, VGO, CEG, SBW, and WCM contributed to drafting the manuscript. All authors reviewed the manuscript critically for intellectual content. All authors read and approved the final draft of the submitted manuscript.

Corresponding author

Correspondence to Kathryn E. Lancaster.

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Authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Previously Reporting

Partial results were reported at Conference on Retroviruses and Opportunistic Infections (CROI). Seattle, WA. March 2019.

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Lancaster, K.E., Lungu, T., Bula, A. et al. Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment. AIDS Behav 24, 1294–1303 (2020). https://doi.org/10.1007/s10461-019-02705-3

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