DISCUSSION
We implemented a person‐centred model for dynamic choice in HIV biomedical prevention in three distinct settings with demographically diverse groups and found that uptake of intervention components, including product, product delivery and HIV testing modality, varied between locations and over time. This model was responsive to client preferences and resulted in higher retention in prevention services than has been observed in previous studies conducted among subgroups of high acquisition risk [We observed the highest uptake of biomedical prevention among women receiving services at ANC. Reflecting ongoing HIV risk, PrEP was the preferred option for nearly all women. As has been reported by others, PrEP use waned over time [Like in the ANC setting, persons in the OPD setting also preferred oral PrEP with a small proportion opting for PEP as the prevention option of choice at subsequent study visits. Surprisingly, unlike the ANC that has inbuilt retention mechanisms for subsequent pregnancy‐related follow‐up visits, we still observed a high proportion of participants accessing prevention at the OPD clinic setting, which may have been as a result of the patient‐centred care delivery model. Participants also increasingly opted for out‐of‐facility delivery over time, possibly allowing for retention of those who would potentially have dropped off from care if service access was restricted to the clinic. As observed in the ANC clinic, the proportion of participants using the self‐testing option increased with time, enhancing convenience and engagement in continued access to prevention services. We speculate that our uptake and retention was high as compared to other PrEP studies because we offered PrEP in HIV‐status‐neutral settings such as OPD and ANC as opposed to the standard practice of offering PrEP at the HIV clinic in these rural settings, a practice that is associated with increased stigma towards PrEP acknowledging that fear or worry of stigma have been expressed as motivations not to use PrEP [In the community setting, overall uptake of biomedical prevention was much lower than in the two clinic‐based settings. Unlike studies conducted using a community mobile clinic or at community locations besides the household that reported high acceptability [Our dynamic choice model included options for product, testing and delivery on the background of supportive patient‐centred services. Training of providers and CHWs on offering choices without imposing their own views on what might be best for the client was an important part of the intervention. This training included not only the principles of choice but also case studies to illustrate how providers can support the agency for client decision‐making. The training emphasized the delivery of warm patient‐friendly services to foster provider−client trust in discussing HIV risk and the best available option without fear of feeling judged. All providers were trained on patient‐centred delivery prior to the baseline visit. There were monthly meetings of providers, as well as scheduled on‐job booster trainings during the course of the study.Our dynamic choice model increased biomedical covered time during self‐reported HIV risk, but fell short of optimal coverage. The opportunity to add novel, emerging biomedical prevention products such as CAB‐LA as one of the choices for prevention holds promise to increase HIV prevention covered time with this option that has been shown to have higher efficacy than oral PrEP and an ability to confer protection over an 8‐week period following a single administration [Our study has a number of strengths and weaknesses. It is among the first to provide evidence from the real world on biomedical choices selected when offered in different contexts (in contrast to theoretical choices via DCEs). Moreover, this study provides evidence of the implementation of PrEP and PEP in ANC, in OPD clinics (primary care settings) and in the community through a CHW‐led model in regions with high HIV prevalence. It presented an opportunity to explore innovative delivery approaches and demonstrate the value of choice in HIV prevention. Limitations of this study include the short duration of follow‐up and reliance on self‐report. In other words, recall bias is a potential concern, which we aimed to minimize by including prompts in our surveys and limiting them to discrete periods (i.e. months). Additionally, the ongoing trial is confirming that clients were actually ingesting PrEP and PEP with objective biomarkers. In this interim analysis, we are able to show that prevention coverage increased from baseline over 24 weeks among intervention participants, but the comparison to a contemporary control population is lacking in this analysis. Upon each trial's completion, we will compare biomedical covered time, overall and during periods of risk, by the randomized arm; this will help quantify the effect of this model on uptake and retention over a longer duration. These results combined with ongoing qualitative studies of provider and client attitudes can shed light on contributions of various elements of our intervention.