Discussion
This paper presents some of the first quantitative and qualitative data exploring the acceptability and preference of adolescent girls and young women in the UChoose study for contraceptive options as a proxy for HIV prevention methods. Our results highlight three key findings: first, the burden of daily use and patterns of poor execution were the most consistently described concerns for future acceptability and preferences for HIV prevention products. Second, despite the initial hesitancy that adolescents aged 15–19 may experience with new products, there is a strong interest in diverse user-controlled prevention methods. Third, participants described adherence barriers, underscoring the need for products that are easy to use and integrate well into adolescents’ lives. Fourth, the ease of administration and long-lasting efficacy were primary factors linked to acceptability and preference among South African adolescents over time. Indeed, the most commonly preferred methods were an injectable option or a vaginal ring from the three pregnancy prevention options. Overall findings revealed adolescents were enthusiastic about HIV prevention that may improve their health. The overall preference feedback for the injectable HIV prevention method was indeed consistent with the main study [Similar to acceptability and preference data from other at-risk groups, adolescent women in our study described the relative trade-offs of each method [Similar to evidence found in other HIV prevention literature, we found that participants commonly reported these concerns for both the vaginal ring and daily pills method, demonstrating a lack of confidence in their ability or agency to use these products habitually [While participants were asked to extrapolate from their contraceptive experience, participants emphasized adherence issues more than how to solve them. Participants acknowledged that no single product had all the favourable characteristics but voted for prevention that ensured ease of use, had ‘full’ protection, and infrequent dosing [Consistent with previous research on the acceptability of new HIV prevention options [We acknowledge that participants may still have given socially desirable answers, despite FGDs having been conducted in an open and non-judgemental manner. Of similar importance, a small study in a single district may influence generalizability to other adolescent populations in the country. Additionally, the FGDs were conducted in 2018 following study completion and relied heavily on retrospective self-report data that is subject to recall bias and misreporting. In light of the study design, FGD participants were selected at the end of the study from the sample of participants who had used at least two of the prevention methods as we required participants to describe and make contrasting comparisons regarding their experience of use. In this study, we attempted to mitigate any recall bias by providing participants reference material at the beginning of each group including the sample products and detailed diagrams and reemphasizing their key role in giving candid feedback [