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A qualitative study to identify critical attributes and attribute-levels for a discrete choice experiment on oral pre-exposure prophylaxis (PrEP) delivery among young people in Cape Town and Johannesburg, South Africa.

南非开普敦和约翰内斯堡年轻人口服暴露前预防 (PrEP) 分娩离散选择实验的关键属性和属性水平的定性研究。

  • 影响因子:2.26
  • DOI:10.1186/s12913-020-05942-8
  • 作者列表:"Dietrich JJ","Atujuna M","Tshabalala G","Hornschuh S","Mulaudzi M","Koh M","Ahmed N","Muhumuza R","Ssemata AS","Otwombe K","Bekker LG","Seeley J","Martinson NA","Terris-Prestholt F","Fox J
  • 发表时间:2021-01-06
Abstract

BACKGROUND:The uptake and adherence of daily oral PrEP has been poor in high-risk populations in South Africa including young people. We used qualitative research methods to explore user preferences for daily and on-demand oral PrEP use among young South Africans, and to inform the identification of critical attributes and attribute-levels for quantitative analysis of user preferences, i.e. a discrete choice experiment (DCE). METHODS:Data were collected between September and November 2018 from eight group discussions and 20 in-depth interviews with young people 13 to 24 years in Cape Town and Johannesburg. Using a convenience sampling strategy, participants were stratified by sex and age. Interviewers used a semi-structured interview guide to discuss several attributes (dosing regimen, location, costs, side effects, and protection period) for PrEP access and use. Group discussions and in-depth interviews were audio-recorded, transcribed verbatim and translated to English. We used framework analysis to explore context-specific attributes and attribute-levels for delivering oral PrEP in South Africa. The adolescent community advisory board, expert and study team opinions were consulted for the final DCE attributes and levels. RESULTS:We enrolled 74 participants who were 51% (n = 38/74) male, had a median age of 18.5 [Interquartile range = 16-21.25] years, 91% (n = 67/74) identified as heterosexual and 49% (n = 36/74) had not completed 12th grade education. Using the qualitative data, we identified five candidate attributes including (1) dosing regimen, (2) location to get PrEP, (3) cost, (4) route of administration and (5) frequency. After discussions with experts and the study team, we revised the DCE to include the following five attributes and levels: dosing regime: daily, and on-demand PrEP; location: private pharmacy, public clinic, mobile clinic, ATM); cost: free-of-charge, R50 (~2GBP), R265 (~12GBP); side effects: nausea, headache, rash; and duration of protection: fulltime protection versus when PrEP is used). CONCLUSIONS:There is limited literature on qualitative research methods describing the step-by-step process of developing a DCE for PrEP in adolescents, especially in resource-constrained countries. We provide the process followed for the DCE technique to understand user preferences for daily and on-demand oral PrEP among young people in South Africa.

摘要

背景: 在南非包括年轻人在内的高危人群中,每日口服PrEP的摄入和依从性一直很差。我们使用定性研究方法来探索年轻南非人对日常和按需口服PrEP使用的用户偏好,并告知关键属性和属性水平的识别,以便对用户偏好进行定量分析,即离散选择实验 (DCE)。 方法: 数据收集时间为2018年9月至11月,来自开普敦和约翰内斯堡13至24年的年轻人的8次小组讨论和20次深度访谈。使用便利抽样策略,按性别和年龄对参与者进行分层。采访者使用半结构化访谈指南来讨论PrEP访问和使用的几个属性 (给药方案、位置、成本、副作用和保护期)。小组讨论和深入访谈是录音的,逐字转录并翻译成英语。我们使用框架分析来探索在南非提供口头准备的上下文特定属性和属性水平。咨询了青少年社区咨询委员会、专家和研究小组对最终DCE属性和级别的意见。 结果: 我们招募了74名参与者,他们是51% (n   = 38/74) 男性,中位年龄为18.5 [四分位距 = 16-21.25] 岁,91% (n   = 67/74) 被确定为异性恋,49% (n   = 36/74) 没有完成12年级教育。使用定性数据,我们确定了五个候选属性,包括 (1) 给药方案,(2) 准备位置,(3) 成本,(4) 给药途径和 (5) 频率。在与专家和研究小组讨论后,我们修改了DCE,包括以下五个属性和级别: 给药方案: 每日和按需准备; 地点: 私人药房、公共诊所、移动诊所、ATM); 费用: 免费,r50 (~ 2GBP),R265 (~ 12GBP); 副作用:恶心,头痛,皮疹; 和保护持续时间: 全职保护与使用PrEP时)。 结论: 关于定性研究方法的文献有限,这些方法描述了在青少年中,特别是在资源有限的国家,逐步开发PrEP DCE的过程。我们提供了DCE技术遵循的流程,以了解南非年轻人对日常和按需口头准备的用户偏好。

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