Heterosexual couples' preferences for dual-purpose prevention products for HIV and pregnancy prevention: the CUPID Study (MTN-045) in Uganda and Zimbabwe


BACKGROUND: Most research with end-users of future HIV prevention products has focused on women despite male partners' important role in product use decision-making. The CUPID Study assesses preferences for future dual-purpose prevention (DPP) products for pregnancy and HIV prevention and examines relationship-based influences pertinent to the development and use of DPP products.
METHODS: CUPID is a multi-methods cross-sectional study targeting 400 heterosexual couples in Uganda and Zimbabwe (female partners aged 18-40 and HIV negative by self-report) iniated in January 2020. Couples complete interviewer-administered surveys individually, followed by a joint interview that includes an interactive Ideal Product Activity (IPA), self-directed by the couple and observed by a trained researcher. The IPA asks couples to select the most preferred characteristics of a DPP product (e.g., delivery form, effect on menses, effects on return to fertility, timing of use and duration of effectiveness). We examined overall attitudes toward DPP products, preferred characteristics elicited in the IPA, and relationship decision-making characteristics associated with these preferences using Poisson regression models with robust standard errors.
RESULTS: Among 117 couples (mean age, females: 27, males: 32) enrolled through March 2020, nearly all (92%) indicated a preference for a dual vs. single purpose product. Primary advantages cited include ease of using a '2 in 1' product and, among females, ability to present the product as only a contraceptive; disadvantages included concerns regarding side effects in a combined product and the need to switch methods when pregnancy is desired. The majority (61%) of couples selected oral tablets as their ideal formulation, while 39% preferred a vaginally-delivered product (ring, insert or film). Though longer-duration products were favored (2-3 months), one-third indicated their ideal product would be monthly and 10% preferred on-demand. Women who reported they usually made their health care decisions individually (vs. jointly with their partner) were less likely to indicate their ideal product as vaginally-delivered (IRR: 0.48, 95% CI: 0.26, 0.90, p=0.02).
CONCLUSIONS: Couples, both individually and jointly, indicated high interest in DPP products that combine HIV and pregnancy prevention. Ideal product characteristics, particularly delivery form, signaled a role for partner engagement and disclosure to support use of vaginally-delivered products.