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  • UPTAKE

Stage 3: A prospective observational cohort study

Stage 3 will run for approximately 6 months and enroll approximately 225 AGYW aged 15 to 24 years in Nairobi, Kenya and 225 FSW aged 18 to 45 years in Kampala, Uganda

The UPTAKE study seeks to accelerate access and facilitate adherence to effective and innovative long-acting (LA) technologies to prevent HIV and unintended pregnancy among Adolescent Girls and Young Women (AGYW) and Female Sex Workers (FSW) in Kenya and Uganda through socio-behavioural research. 


This four-stage research study is being conducted in Nairobi, Kenya and Kampala, Uganda from October 2020 to October 2024. Stage 1 data collection wrapped up in June 2022. In this first stage, we explored structural, social, interpersonal, and individual factors that influence a woman's motivation to use existing and future contraception and HIV prevention products. Stage 2 wrapped up in December 2023 and explored market segmentation and behavioural intervention design through the use of quantitative and qualitative social-behavioural research approaches. 


High impact product development approaches must consider the needs, preferences, and behaviours of end-users in early stages of development when product attributes may change without major financial impact. In this study, we aim to assess the preferences for joint use of HIV prevention and LA marketed contraceptive products, based on actual usage, among girls and women at high risk of HIV infection in Kampala and Nairobi. The joint use of HIV prevention and contraceptives can serve as proxy for future use of LA HIV prevention products and MPTs, helping inform their development. Furthermore, the development of support strategies based on a behavioural economics approach (for example, tailored messages for uptake and adherence support) for women to use PrEP along the prevention cascade is important for improving prevention-effective use of oral PrEP as well as informing successful introduction and integration of current and future HIV prevention tools with family planning and other SRH services.   


Stage 3 began in February 2024. This prospective observational cohort study will run for approximately 6 months and enroll approximately 225 AGYW aged 15 to 24 years in Nairobi, Kenya and 225 FSW aged 18 to 45 years in Kampala, Uganda. The purpose of this study is to implement an integrated social behavioural intervention and to assess the preferences for HIV prevention use and joint use with LA marketed contraceptive products, based on actual usage, among women at high risk of HIV infection in Kampala and Nairobi. Women are eligible to participate if they are interested in using any HIV prevention, are using a modern family planning method, and are willing to participate.   


The main outcome of Stage 3 is persistent use of a currently available HIV prevention technology at 6 months. Persistent use is defined as continuously returning for PrEP pills refills at month 1, month 3 and month 6. More specifically, stage 3 has the following objectives:  

  1. To design support messages, based on a previous market segmentation analysis, for women at high risk of HIV infection and integrate them into a differentiated service delivery package in two urban sites.; 

  1. To describe women’s relative preferences for use of HIV prevention and LA marketed contraceptive products; 

  1. To analyse socio demographic, behavioural and qualitative data and assess factors underlying preferences and reasons for changes in HIV prevention and LA contraceptive method choices over six months;  

  1. To analyse service utilisation and estimate the cost of delivery of a differentiated service delivery package (health service perspective); 

  1. To estimate the potential cost to service users of accessing the differentiated service delivery package (patient perspective); and 

  1. To estimate the potential cost effectiveness of use of LA HIV prevention products in development if introduced within a differentiated service delivery package. 


Our hypothesis for stage 3 is that concurrent use of LA PrEP with family planning and self-care products might improve outcomes. Initial results of Stage 1 support this hypothesis that women seem inclined to prefer hypothetical LA PrEP consistently with their current LA family planning use. A sub-group analysis will focus on the quantitative comparison between two groups – those women using LA family planning products (i.e. IUD, implants, and injections) and those using other daily-event based family planning methods (I.e. oral pill). We will complement this comparison with participatory workshops to understand personal trade-offs between the needs, benefits, and challenges when using both family planning and HIV prevention methods. 


We will investigate program indicators through routine data collected at scheduled visits. We will also describe women’s uptake and persistent use of products and services and assess their preferences and acceptability of future product designs. Finally, we will document costs of delivery from a health service perspective as well as costs of accessing care from a patient perspective. These costs and utilisation data will inform parameters for a cost effectiveness assessment of introducing future HIV prevention technologies in a differentiated care framework. 

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