Open AccessPreferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment
Author(s) -
Kathryn E. Lancaster,
Thandie Lungu,
Agatha Bula,
Jaclyn Shea,
Abigail B. Shoben,
Mina C. Hosseinipour,
Racquel E. Kohler,
Irving Hoffman,
Vivian F. Go,
Carol E. Golin,
Stephanie B. Wheeler,
William C. Miller
Publication year - 2019
Publication title -
aids and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.994
H-Index - 106
eISSN - 1573-3254
pISSN - 1090-7165
DOI - 10.1007/s10461-019-02705-3
Subject(s) - health psychology , focus group , medicine , pre exposure prophylaxis , logistic regression , public health , service delivery framework , environmental health , service provider , family medicine , interview , demography , human immunodeficiency virus (hiv) , service (business) , nursing , men who have sex with men , syphilis , business , marketing , sociology , political science , law
Female sex workers (FSW) in Malawi have among the highest HIV prevalence estimates worldwide. Daily oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet preferences for PrEP delivery among FSW are lacking. Eight focus group discussions, a literature review, and cognitive interviews were conducted to identify modifiable PrEP delivery attributes and inform discrete-choice experiment (DCE) development for FSW in Lilongwe. Enrolled FSW received an interviewer-assisted DCE. Data were analyzed using mixed logit regression. Dispensing location was most preferred, followed by the provision of additional services. Women preferred receiving PrEP at family planning clinics or non-governmental organization run drop-in centers. Cervical cancer screening was the most preferred additional service, while pregnancy testing and partner risk reduction counseling were less valued. This study was the first study to examine PrEP delivery preferences in Malawi using DCE-a powerful elicitation tool to apply to other key populations at risk for HIV.