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

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dc.contributor.authorDietrich, Janan J
dc.contributor.authorAtujuna, Millicent
dc.contributor.authorTshabalala, Gugulethu
dc.contributor.authorHornschuh, Stefanie
dc.contributor.authorMulaudzi, Mamakiri
dc.contributor.authorKoh, Michelle
dc.contributor.authorAhmed, Nadia
dc.contributor.authorMuhumuza, Richard
dc.contributor.authorSsemata, Andrew S
dc.contributor.authorOtwombe, Kennedy
dc.contributor.authorBekker, Linda-Gail
dc.contributor.authorSeeley, Janet
dc.contributor.authorMartinson, Neil A
dc.contributor.authorTerris-Prestholt, Fern
dc.contributor.authorFox, Julie
dc.date.accessioned2021-10-11T08:29:15Z
dc.date.available2021-10-11T08:29:15Z
dc.date.issued2021-01-06
dc.date.updated2021-01-10T04:12:46Z
dc.description.abstractBackground 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.en_US
dc.identifier.apacitationDietrich, J. J., Atujuna, M., Tshabalala, G., Hornschuh, S., Mulaudzi, M., Koh, M., ... Fox, J. (2021). 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. <i>BMC Health Services Research</i>, 21(Article number: 17), http://hdl.handle.net/11427/35141en_ZA
dc.identifier.chicagocitationDietrich, Janan J, Millicent Atujuna, Gugulethu Tshabalala, Stefanie Hornschuh, Mamakiri Mulaudzi, Michelle Koh, Nadia Ahmed, et al "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." <i>BMC Health Services Research</i> 21, Article number: 17. (2021) http://hdl.handle.net/11427/35141en_ZA
dc.identifier.citationDietrich, J.J., Atujuna, M., Tshabalala, G., Hornschuh, S., Mulaudzi, M., Koh, M., Ahmed, N. & Muhumuza, R. et al. 2021. 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. <i>BMC Health Services Research.</i> 21(Article number: 17) http://hdl.handle.net/11427/35141en_ZA
dc.identifier.ris TY - Journal Article AU - Dietrich, Janan J AU - Atujuna, Millicent AU - Tshabalala, Gugulethu AU - Hornschuh, Stefanie AU - Mulaudzi, Mamakiri AU - Koh, Michelle AU - Ahmed, Nadia AU - Muhumuza, Richard AU - Ssemata, Andrew S AU - Otwombe, Kennedy AU - Bekker, Linda-Gail AU - Seeley, Janet AU - Martinson, Neil A AU - Terris-Prestholt, Fern AU - Fox, Julie AB - 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. DA - 2021-01-06 DB - OpenUCT DP - University of Cape Town IS - Article number: 17 J1 - BMC Health Services Research KW - Discrete choice experiment (DCE) KW - Conjoint analysis KW - HIV KW - Oral pre-exposure prophylaxis (PrEP) KW - Preferences KW - Adolescents KW - Young people KW - South Africa LK - https://open.uct.ac.za PY - 2021 T1 - 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 TI - 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 UR - http://hdl.handle.net/11427/35141 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12913-020-05942-8
dc.identifier.urihttp://hdl.handle.net/11427/35141
dc.identifier.vancouvercitationDietrich JJ, Atujuna M, Tshabalala G, Hornschuh S, Mulaudzi M, Koh M, et al. 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. BMC Health Services Research. 2021;21(Article number: 17) http://hdl.handle.net/11427/35141.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDesmond Tutu HIV Centreen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Health Services Researchen_US
dc.source.journalissueArticle number: 17en_US
dc.source.journalvolume21en_US
dc.source.urihttps://bmchealthservres.biomedcentral.com/
dc.subjectDiscrete choice experiment (DCE)en_US
dc.subjectConjoint analysisen_US
dc.subjectHIVen_US
dc.subjectOral pre-exposure prophylaxis (PrEP)en_US
dc.subjectPreferencesen_US
dc.subjectAdolescentsen_US
dc.subjectYoung peopleen_US
dc.subjectSouth Africaen_US
dc.titleA 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 Africaen_US
dc.typeJournal Articleen_US
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