Preferences for Long-Acting HIV Pre-Exposure Prophylaxis among Women of Reproductive Age in Low- and Middle-income Countries: A Systematic Review.

HIV remains a major public health problem in low- and middle-income countries (LMICs). While oral pre-exposure prophylaxis (PrEP) is documented as safe and effective for HIV prevention, adherence remains a challenge. Long-acting PrEP could address adherence challenges associated with oral PrEP and significantly reduce HIV acquisition among high-risk populations. However, evidence of preferences for long-acting products remains limited, especially in LMICs. Understanding the preferences is crucial for informing the design of interventions to enhance not only adherence but also uptake. We conducted a systematic review to investigate preferences for long-acting PrEP among women of reproductive age (WRA), 15-49 years in LMICs. We searched PubMed, CINAHL and EMBASE databases for empirical literature relevant to our study, published between January 2010 and April 2024. Additional articles were manually searched for in the reference lists of included articles. We identified 20 studies reporting preferences for long-acting PrEP alone or in comparison with short-acting PrEP, such as oral daily pills, vaginal gels or suppositories. We found that WRA preferred long-acting PrEP products comprising injectables, implants and vaginal rings over short-acting options. The preferences were associated with product attributes, including longer duration of action, less frequent dosing, effectiveness and fewer side effects. The findings suggest that, in addition to oral PrEP, long-acting PrEP products can be employed as a strategy to reduce the burden of HIV among WRA in LMIC settings. Further research should be conducted to evaluate preferences in specific population groups, such as pregnant and lactating women, especially in high HIV prevalence settings.