End-user preferences for biomedical HIV prevention products and service delivery models: a mixed methods study with female university students in Zambia

Adolescent girls and young women in sub-Saharan Africa are disproportionately affected by HIV. We determined acceptability and desirability of pre-exposure prophylaxis products and delivery modalities among female university students in Zambia. In 2022, we conducted an online survey (n = 806) and focus group discussions (n = 34) with female students at a public university in Zambia, focused on PrEP products and service delivery preferences. Descriptive statistics and qualitative themes were integrated, compared, and synthesized. The most preferred PrEP products were once-a-month oral pills (35%); a one-time vaccine (33%); and 2-monthly or 3-monthly injection (20%). Few (<5%) preferred the implant, vaginal gel, or vaginal ring. Qualitative themes confirmed preferences for longer-acting PrEP options. However, some participants were hesitant to use an injection and expressed desire for an oral pill that could be taken after sex. Any product that required insertion into the vagina was generally unacceptable and least desired. Most (54%) participants wanted to access PrEP in a non-clinical setting due to anticipated stigma of being seen at an HIV clinic/service area. Expanding PrEP choices, specifically longer-acting and on-demand products, along with differentiated service delivery models beyond the traditional HIV clinic are desirable attributes to female university students in Zambia.