Oral pre-exposure prophylaxis (PrEP) is about 99 percent effective in reducing the risk of contracting HIV from sex, but that’s only if it’s taken daily. When users forget, lack motivation for taking a daily pill or experience barriers to getting the drug, risk goes up.

An implantable, biodegradable PrEP device, currently in clinical trials, may address those problems. But what will it take for health care providers (HCPs) to prescribe it and women to use it?

To help understand, Morgan Brown, a USF College of Public Health DrPH student in Advanced Practice Leadership, and colleagues from Population Services International (PSI) and Eastern Virginia Medical School, surveyed female sex workers and HCPs in South Africa, which has the highest number of people living with HIV globally.

They decided to focus on women, said Brown, because some of the study sample already had experience with implantable devices. Likewise, some of the HCPs also were familiar with prescribing implantable contraceptives.

“We hoped that use of an implantable product comparable to implantable contraceptives would provide some frame of reference to respondents,” said Brown, who at the time of the study worked for PSI but currently is a data and learning specialist at Q2 Impact, an international company based in Virginia that addresses global issues. Brown supports monitoring and evaluation efforts of a USAID Feed the Future award.

Their study, “End-user research in support of long-acting systemic antiretroviral delivery systems: insights from qualitative research with providers and target users in South Africa,” was published in the journal BMC Infectious Diseases in December.

So, what did both prescribers and users want to see in an implantable PrEP device?

“Overall, the device needs to be highly effective, offer long-lasting protection and result in minimal adverse side effects,” Brown noted.

The women in the study expressed a high degree of willingness to try the device, citing that they liked the convenience and dissolvability of the implant. HCPs liked it for the same reasons, but some worried that it could increase promiscuity and noted that it didn’t protect against sexually transmitted infections.

Marketing the product—which consists of four pellets, bigger than a penny but smaller than a matchstick—properly will be key to its success, Brown noted.

“Overall awareness of PrEP was very low in this study, so we as public health practitioners need to do a better job of communicating PrEP’s availability and effectiveness, both in its current form and when other forms like the implant become available,” Brown explained. “The main benefit of implantable PrEP is that it removes the adherence barrier of traditional, oral PrEP, which must be taken daily,” she added. “By removing end-user barriers and making it easier for people to protect themselves, this could be a massive win in the fight against HIV.”

Story by Donna Campisano, USF College of Public Health