JMIR Publications

ABSTRACT

Background:

A long-acting implanted medication delivery device (IMDD) for HIV pre-exposure prophylaxis (PrEP) is in development in the Sustained Long-Action Prevention Against HIV (SLAP-HIV) trial. This strategy could provide an alternative to oral PrEP. Our mixed-methods study aimed to understand: 1) users’ experiences with a similar RIMDD for contraception, and 2) factors influencing the likelihood that gay/bisexual men (GBM) would use a proposed PrEP

Objective:

Our study aimed to understand: 1) users’ experiences with existing IMDDs for other indications, and 2) factors influencing the likelihood that gay/bisexual men (GBM) would use a PrEP IMDD.

Methods:

Work was completed in four stages. In Stage 1, we conducted a scientific literature review on existing IMDDs, focused on users’ experiences with the IMDD devices (as opposed to users’ experiences with the medications contained in the IMDD). In Stage 2, we reviewed videos on YouTube.com, focusing on the experiences of current/former contraceptive IMDD users, which are more commonly used than non-contraceptive IMDDs. In Stage 3, individuals who indicated use of an IMDD (for contraception, since these IMDDs are most similar to that in development in SLAP-HIV) in the last 5 years were recruited via an online questionnaire, advertised on Facebook. Eligible participants (n=12 individuals who liked IMDDs a lot; n=12 individuals who disliked IMDDs a lot) completed in-depth phone interviews (IDIs) about their experiences. In Stage 4, results from IDIs were used to develop an online survey for HIV-negative GBM to rate their likelihood of using a PrEP IMDD on a scale (1=very unlikely, 5=very likely) based on likely device characteristics and IMDD concerns identified in the IDIs.

Results:

In the scientific literature review (Stage 1), concerns about IMDDs that could apply to the PrEP IMDD in development included potential side-effects (e.g., headache), anticipated high cost of the device, misconceptions about IMDDs (e.g., specific contraindications), and difficulty accessing IMDDs. In the Stage 2 YouTube.com review, individuals who had used contraceptive IMDDs reported side-effects related to their device, though they were typically mild. In Stage 3, IMDD users reported that devices were comfortable, un-intrusive, and presented only minor discomforts (e.g., bruising) before/after insertion and removal. They mainly reported removing or disliking the device due to contraceptive-related side effects (e.g., prolonged menstruation). Participants in the Stage 4 quantitative survey (N=304) were mainly gay (86%), White (53%) or Latino (24%), cisgender men (97%); 31% were on oral PrEP. Not having to take a daily pill increased likeliness to use PrEP IMDDs (mean: 4.13). Requiring >1 device to achieve 1 year of protection (mean range: 1.79-2.94) mildly discouraged IMDD use. Participants did not mind moderate bruising, a small scar, tenderness and/or bleeding after insertion/removal, and an implant slightly larger than a matchstick (mean ratings: 3.18-3.69).

Conclusions:

PrEP IMDDs are promising among GBM. Implant features and insertion/removal-related concerns do not seem to discourage potential users. To ensure acceptability, PrEP IMDDs should require the fewest possible implants for the greatest protection duration.