<i>‘ … they just take one pill, so it is easy to use, more convenient … ’</i> : South African health care provider perspectives on a Dual Prevention Pill

Abstract

The Dual Prevention Pill (DPP) is a daily oral pill containing oral pre-exposure prophylaxis (PrEP) for protection against HIV and a combined oral contraceptive (COC) for the prevention of unintended pregnancy, currently under development. However, little is known about healthcare providers' (HCPs) perspectives on this potential new multipurpose prevention technology (MPT). A more granular understanding of HCP views about the DPP may support efforts to ensure equitable introduction of and access to this innovative technology. We conducted in-depth interviews with 17 HCPs working at family planning (FP) and HIV service sites in Johannesburg, South Africa. We used a qualitative framework analysis to examine HCP perspectives on potential end-users, the DPP concept and health system-related considerations. HCPs articulated that the DPP would meet the needs of their clients, contribute to more efficient and effective integrated sexual and reproductive health service delivery and meet broader community goals for the reduction in HIV infections and unintended pregnancies. HCPs noted concerns and potential challenges with the product's daily dosing regimen, potential for exacerbated side effects (compared to oral PrEP or COCs taken alone) and potential ethical considerations about offering the DPP to adolescents. HCPs felt the DPP should be available through public health care facilities to maximise outreach and ensure appropriate care, and discussed community-based delivery options for expanded outreach. They also noted the need to address provider biases, particularly when serving adolescents, as well as the accompanying demand creation efforts with end-users and educational campaigns in the community. Understanding providers' support for the DPP, as well as the potential challenges they foresee, should inform market introduction strategies, clinic counselling guidelines and provider training for the DPP. We underscore the need to engage with HCPs early (prior to product introduction) to understand local barriers and facilitators to ensure quality sustained rollout and support for MPTs.