Preferences and Trade-offs for Attributes of Long-Acting HIV Prevention Products Among Pregnant and Breastfeeding Women in Kenya: A Discrete Choice Experiment.

Novel long-acting HIV-prevention products offer a promising solution to adherence challenges related to daily pre-exposure prophylaxis (PrEP) use. We conducted a discrete choice experiment (DCE) to examine preferences for long-acting HIV-prevention products (oral tablets, injections, vaginal rings, and implants) among pregnant and breastfeeding women (PBFW) in Kenya. We developed a D-efficient experimental design incorporating six attributes, specifically dose frequency, effectiveness, prevention of sexually transmitted infections (STIs), prevention of pregnancy, product access location, and cost. Choice data were collected from 350 respondents (179 pregnant and 171 breastfeeding women) from Kiambu and Kisumu counties and were analysed using panel mixed multinomial logit models. Compared to oral products, the implant was the most preferred HIV-prevention product (β = 3.604), followed by injection (β = 3.078), and vaginal ring (β = 0.153). PBFW also preferred products with the ability to prevent STIs (β = 2.364) and pregnancies (β = 1.450), offered longer dosing intervals (β = 1.296), and had higher effectiveness (β = 0.543). Cost emerged as a significant factor, with PBFW willing to pay more for products offering higher effectiveness and additional STI and pregnancy prevention benefits. These findings emphasise the importance of affordable, effective, and multipurpose long-acting HIV-prevention products tailored to the preferences of PBFW. Expanding product options will enhance uptake and adherence to HIV prevention efforts in this vulnerable population.