The Dual Prevention Pill (DPP) is a daily oral pill containing oral pre-exposure prophylaxis (PrEP) for protection against HIV and a combined oral contraceptive (COC) for the prevention of unintended pregnancy, currently under development. However, little is known about healthcare providers' (HCPs) perspectives on this potential new multipurpose prevention technology (MPT). A more granular understanding of HCP views about the DPP may support efforts to ensure equitable introduction of and access to this innovative technology. We conducted in-depth interviews with 17 HCPs working at family planning (FP) and HIV service sites in Johannesburg, South Africa. We used a qualitative framework analysis to examine HCP perspectives on potential end-users, the DPP concept and health system-related considerations. HCPs articulated that the DPP would meet the needs of their clients, contribute to more efficient and effective integrated sexual and reproductive health service delivery and meet broader community goals for the reduction in HIV infections and unintended pregnancies. HCPs noted concerns and potential challenges with the product’s daily dosing regimen, potential for exacerbated side effects (compared to oral PrEP or COCs taken alone) and potential ethical considerations about offering the DPP to adolescents. HCPs felt the DPP should be available through public health care facilities to maximise outreach and ensure appropriate care, and discussed community-based delivery options for expanded outreach. They also noted the need to address provider biases, particularly when serving adolescents, as well as the accompanying demand creation efforts with end-users and educational campaigns in the community. Understanding providers’ support for the DPP, as well as the potential challenges they foresee, should inform market introduction strategies, clinic counselling guidelines and provider training for the DPP. We underscore the need to engage with HCPs early (prior to product introduction) to understand local barriers and facilitators to ensure quality sustained rollout and support for MPTs.

Background:We assessed US women's preferences to inform development of a novel nonhormonal multipurpose prevention technology (MPT)-a vaginal ring to prevent pregnancy, HIV, sexually transmitted infections (STIs), and bacterial vaginosis (BV). Methods:In cross-sectional online surveys with US women ages 18-49 currently/interested in using contraception, we conducted a discrete choice experiment (DCE) comprising 7 MPT ring attributes. Mixed multinomial logit models examined relative attribute importance and sub-population preferences. Results:Of 2,105 survey completers (mean age 31) from all 50 states (Dec 2023 to Jan 2024), 53% were married/cohabiting, 57% had ≥1 child, 43% ever had an unintended pregnancy, and 9% had an STI in the past year. Participants valued effectiveness for contraception about twice as much as for HIV prevention and about 3 times that of STI prevention. Younger women (18-29 vs. 30-49) desired higher pregnancy and HIV prevention effectiveness. Women who were worried about HIV valued effectiveness for HIV and pregnancy similarly. While most women valued BV prevention and no menstrual side effects, a nonhormonal formulation mattered only to women averse to hormonal contraception (61%) and on-demand use (vs. continuous-use only) was not preferred. Women were willing to trade off some pregnancy prevention effectiveness for other desired attributes. Overall, 73% reported being likely/very likely to use a nonhormonal MPT ring at moderate protection levels (80% pregnancy, 50% HIV/STIs). Conclusions:Interest in an MPT ring was strong, even with conservative effectiveness estimates. Preferences and desired levels of prevention effectiveness and nonhormonal options were shaped by contraceptive history and personal context.

Objective HIV risk perception is considered a key step in the HIV prevention cascade, a crucial motivational process through which individuals may consider their HIV prevention options. We sought to determine whether an anonymous self-administered chatbot in clinic waiting areas could improve HIV knowledge, enhance individualised HIV risk assessment and ease client-provider interactions regarding HIV prevention.Methods and analysis We piloted a digital chatbot with cisgender women and transgender men seeking HIV and sexual health services at community-based clinics and public health facilities in Lagos, Nigeria. Participants completed a self-administered survey (n=150) after their healthcare provider (HCP) visit to provide feedback on their chatbot experience. Additional follow-up indepth interviews with chatbot users (n=25) and participating HCPs (n=10) probed on their experiences with the chatbot and chatbot users and effect on the client-provider interaction.Results Participants reported gaining new knowledge about HIV and pre-exposure prophylaxis (PrEP) from the chatbot that made them consider their own HIV vulnerability and prevention options. Participants reported feeling more comfortable in discussing PrEP with HCPs and about one-half reported that they initiated a conversation about HIV prevention with their provider. HCPs reiterated that the interaction was more productive with clients who had used the chatbot vs their usual interactions. Participants requested additional health information and access to the chatbot outside of the clinic setting.Conclusion The chatbot served as a vital patient activation and self-care tool; it facilitated participants’ understanding of HIV, risk perception/vulnerability, knowledge about effective prevention options and self-efficacy to initiate discussion with HCPs—critical steps in HIV prevention.

Adolescent girls and young women (AGYW) in Zimbabwe bear a double burden of HIV and unmet need despite the progress made in provision of family planning and oral pre-exposure prophylaxis (PrEP). We elicited opinions from AGYW and health care providers (HCPs) about a dual prevention pill (DPP) in development that combines oral contraceptives (OCs) with oral PrEP to simultaneously prevent unintended pregnancy and HIV, and potentially increase uptake and adherence to oral PrEP. We enrolled 44 participants (March-June 2021) and conducted 12 in-depth interviews with HCPs (nurses, counselors, social workers, pharmacists, clinicians) from public and private health facilities offering HIV and family planning services in Harare, and four focus group discussions (FGDs) with 32 AGYW who were current OC users, stratified by age (16-19, 20-24). The HCPs and AGYW welcomed the idea of the DPP. Both groups perceived the benefits of the DPP as lessening the burden of taking two separate pills and giving AGYW the option to protect themselves discreetly, potentially increasing adherence and ease of use. HCP's had favorable attitudes toward the DPP and highlighted that the DPP regimen is already similar to the OCs women are taking and would allow for regular menses and quick return to fertility. Despite concerns about potential side effects and lack of protection against sexually transmitted infections (STIs) other than HIV, HCPs noted the potential benefits of the DPP in reducing their workload and increasing the uptake of PrEP services. From the end user perspective, the DPP size, color, and packaging should be appealing and distinct from HIV medications to minimize stigma. Clear guidelines are deemed necessary for DPP service provision for adolescents, emphasizing the importance of tailored approaches for different age groups. Educating male partners and the broader community about the DPP could enhance its use among AGYW.

Awareness and uptake of HIV pre-exposure prophylaxis (PrEP), a highly efficacious medication for HIV prevention, remains low in many sub-Saharan African countries. This study explored the acceptability and feasibility of an HIV prevention chatbot tailored for cisgender women and transgender men in Lagos, Nigeria. The chatbot was developed and implemented in the Nigerian healthcare context using participatory approaches engaging HIV healthcare providers and representatives from the target populations to ensure that the content was appropriate, comprehensible, and non-stigmatizing. The chatbot included information about PrEP, HIV risk/ vulnerabilities, and self-assessment guidelines. The pilot was conducted among 150 participants (132 cisgender women and 18 transgender men) recruited at public health facilities and community health clinics. The chatbot was well-received by clients and healthcare providers and has the potential for rapid scale-up to facilitate PrEP uptake among HIV vulnerable populations. Participants reported the chatbot was easy to understand (97%), a good way to learn health information (99%), and that they would recommend it to others (96%). Participants appreciated the confidentiality of the chatbot, the conversational prompts and offered suggestions to make the chatbot more accessible and user-friendly. Most participants (92%) reported that they learned new information about HIV from the chatbot.

Objectives Evidence regarding interventions to engage men and boys to improve sexual and reproductive health and rights (SRHR) has grown rapidly across subtopics such as HIV, family planning and gender-based violence (GBV). We conducted a review of the effectiveness of interventions to engage men and boys across SRHR domains, lessons learnt about successful programming, and about harms/unintended consequences, in low- and middle-income countries (LMIC).Design Systematic review of reviews following Cochrane guidelines.Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane were searched (18 October–9 November 2022; 9 September 2024).Eligibility criteria Eligible reviews were published since 2015, covered WHO-defined SRHR domain(s) and focused mostly on LMIC.Data extraction and synthesis Data extraction by multiple reviewers focused on intervention effectiveness, implementation best practices, unintended consequences, and quality/risk of bias.Results Thirty-five systematic reviews were included, comprising ~960 primary studies. Reviews focused on HIV prevention/care, reproductive health, maternal and newborn health, and GBV. Reviews consistently concluded that men were successfully engaged, yielding benefits to both women and men’s SRHR outcomes; no adverse intervention impacts on prevalence of SRHR outcomes were reported. We summarised the interventions most consistently found to be effective across reviews, in a programmer-friendly visual mapped onto a framework of men as clients, partners and agents of change. Person-centred, gender-transformative, multilevel approaches were most effective. Remaining evidence gaps include engaging men as contraceptive users, sexually transmitted infections other than HIV, preventing unsafe abortion and SGBV as experienced by men and boys.Conclusions There is substantial evidence supporting a range of successful interventions to engage men and boys to improve SRHR, with markedly similar principles and approaches emerging across SRHR domains. It is time to scale up and integrate these strategies, monitoring for any potential harms and tailoring as needed to socio-cultural contexts and for specific vulnerable subpopulations.

Adolescent girls and young women (AGYW) in sub-Saharan Africa are at risk for HIV/unintended pregnancy. Adherence and continuation to effective oral pre-exposure prophylaxis (PrEP) are limited in AGYW. We hypothesized that an over-encapsulated dual prevention pill (DPP) combining PrEP + oral contraceptive (OC) would be preferred, acceptable, and improve adherence compared to PrEP alone. We randomized HIV-uninfected, 16-24 year-olds 1:1 to use DPP or 2-pill regimen (2PR -PrEP and OCs separately) for three 28-day cycles each. We compared preference for DPP vs. 2PR (exact binomial test) and regimen effects on four acceptability domains: use attributes, product attributes, side effects, impact on sex (Wilcoxon signed-rank tests). Adherence was compared by regimen and sequence (mixed-effects logistic regression) using self-report, pill-count, tenofovir-diphosphate levels in dried blood spots (DBS), indicating ≥ 4 doses per week(≥ 500 fmol/punch at Month 1 and ≥ 700 fmol/punch at Months 2-6). 26/30 participants (mean age 19.4years) completed the study (Nov 2022-Sept 2023). 62% preferred DPP, 38% 2PR (p = 0.24). Most rated both regimens as acceptable, with no differences between them (all p > 0.05). Adherence was high by self-report (98%) and pill-count (97%), but low based on DBS results (DPP: mean 392 fmol/punch, 2PR: mean 384 fmol/punch); with only 10% consistently adherent. There was no difference in adherence by regimen, though odds were higher in period 1 vs. 2 (AOR 3.7; 95% CI 1.10-12.8). Both regimens were safe; 2 pregnancies occurred during the DPP regimen, with no HIV seroconversions. No significant differences in preference, acceptability, and adherence between DPP and 2PR were found in this study. Adherence was low and waned over time. A larger study with a smaller co-formulated DPP may better inform its impact on HIV and pregnancy prevention.The study has been registered at ClinicalTrials.gov Identifier NCT04778514.

Background:A dual prevention pill (DPP) for co-delivery of pregnancy and HIV prevention is currently in development and will offer an alternative to taking two separate products. We examined behavioral, partnership/interpersonal, social, and structural correlates of preferences for an over-encapsulated DPP (as a proxy for the product in development, consisting of oral contraceptive pill and oral PrEP pill) among women and adolescent girls in South Africa and Zimbabwe to inform DPP introduction and counseling strategies. Methods:This secondary analysis used data from two clinical crossover studies that compared the acceptability, adherence, and preference for the over-encapsulated DPP versus separate PrEP and oral contraceptives. HIV-uninfected, non-pregnant cisgender women were enrolled in Johannesburg, South Africa (n = 96, ages 18-40) and Harare, Zimbabwe (n = 30, ages 16-24). Participants were randomized 1:1 to use either DPP or two separate pills for three 28-day cycles, then switched. Preferences were measured at the end of crossover and via exit in-depth interviews. Results:The mean age was 27 years in South Africa and 19 years for Zimbabwe. Most participants had completed secondary school. Childbearing was more common in Zimbabwe (97%) than South Africa (74%). Pregnancy prevention was highly valued in both sites (~ 90%), but Zimbabwean participants voiced greater concern about HIV. DPP preference was higher in Zimbabwe (62%) than South African (39%). In South Africa, DPP preference was associated with behavioral factors (anal sex, experience of sexual violence, relationship conflict, and transactional relationships/sex) and product characteristics (ease of use, side effects). In Zimbabwe, concern about HIV acquisition, interpersonal power, and structural factors (i.e., food insecurity and housing security) were associated with DPP preference. Qualitative interviews highlighted the DPP's simplicity as key advantage over two separate pills, though participants desired a smaller DPP and more discreet packaging to reduced stigma and ease use. Conclusions:While women in both countries value integrated HIV and pregnancy prevention, distinct demographic, behavioral, and social factors influence DPP preference. Tailoring DPP introduction and support strategies to address specific challenges-such as relationship dynamics and product usability-may optimize the acceptance and effectiveness of dual prevention strategies.

Background Expanding contraceptive options could better meet users’ diverse needs and preferences. Annovera ® is a contraceptive vaginal ring that provides a year of pregnancy prevention while remaining under user control and allowing for regular menstrual cycles. This method may also help to reduce burdens on some health care and supply chain systems. However, knowledge gaps exist regarding initial and ongoing acceptability of contraceptive vaginal rings in African settings. Methods We will undertake an open-label, non-randomized, two-arm, parallel clinical acceptability study with an embedded qualitative component, based in clinics providing contraceptive services in Kenya and Zimbabwe. Women aged 18-45 interested in newly initiating or switching contraception will choose from among all available contraceptive options, including Annovera. We aim to enroll 200 participants selecting Annovera and 200 participants selecting either contraceptive injectables or pills. We will compare method uptake, continuation, and satisfaction over one year. Participants will complete questionnaires administered by study staff during two in-person visits (a screening/enrollment visit, and an end of study visit after 52 weeks of method use or at discontinuation) and four phone appointments (at 4, 12, 24, and 36 weeks of use). We will evaluate used rings for discoloration and residual drug levels. The qualitative component involve in-depth interviews with women in the clinical study, their sexual partners, and their service providers, to further examine drivers of and barriers to interest in and use of contraceptive vaginal rings. Discussion This study will explore acceptability of contraceptive vaginal rings in ‘real-world’ contraceptive service settings in two African countries. Findings will be based on actual ring use and contextualized via comparison to two other commonly available methods. As vaginal rings are being considered for multiple reproductive health indications, this work can fill key knowledge gaps and empower decision-makers with information needed to inform future investments in reproductive health.

Introduction Oral pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention method; however, uptake and persistence have been low among southern African women. A dual prevention pill (DPP) that combines PrEP with oral contraception (OC) may increase PrEP use and better meet women’s sexual and reproductive health needs. We will gauge the DPP’s acceptability in two cross-over clinical trials.Methods and analysis PC952 (Zimbabwe) and PC953 (South Africa) will compare acceptability, adherence and preference for an over-encapsulated DPP versus PrEP and OCs taken separately. HIV-negative, non-pregnant cisgender females in Johannesburg, South Africa (n=96, 16–40 years) and Harare, Zimbabwe (n=30, 16–24 years) will be randomised 1:1 to the order of regimens—DPP or two separate tablets—each used for three 28-day cycles, followed by a 6-month choice period in South Africa. Monthly clinic visits include HIV and pregnancy testing; safety assessments and risk reduction and adherence counselling. We will assess adherence (monthly) based on tenofovir diphosphate drug levels in dried blood spots and by self-report. We will evaluate acceptability (monthly) and preference (end of cross-over) via computer-assisted self-interviewing and in-depth interviews with a subset of participants. Data collection started in September 2022 and ended in January 2024.Ethics and dissemination PC952 was approved by the Ministry of Health and Child Care, Medical Research Council, Research Council and Medicines Control Authority of Zimbabwe; the Chitungwiza City Health Ethics Committee; and the Joint Research Ethics Committee for the University of Zimbabwe Faculty of Medicine and Health Sciences and Parirenyatwa Group of Hospitals. PC953 was approved by the South African Health Products Regulatory Authority and the University of the Witwatersrand’s Human Research Ethics Committee. The Population Council IRB approved both studies. We will disseminate results in open-access journals, clinical trials registries, and at local and international meetings and conferences.Trial registration numbers NCT04778514, NCT04778527.

Abstract Background HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women in Johannesburg, South Africa. Methods Between March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16–40 stratified by ages (16–17, 18–24, 25–40), half of whom were COC users. We explored adolescent girls and women’s opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis. Results The majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient “two-in-one” solution, requiring one clinic visit for both PrEP and COCs. AGYW were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers. Conclusions/significance The DPP was perceived as acceptable for HIV and pregnancy prevention to AGYW in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence.

Abstract Background Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women’s participation in decision-making and its influence on reproductive health behaviors. Methods Cross-sectional survey with married women (15–49 years, N = 2,672) in Maradi and Zinder Niger assessed women’s participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women’s participation in decision-making. Results Only 16% of the respondents were involved—either autonomously or jointly with their spouse—in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06–1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. Conclusion Women’s engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women’s involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women’s decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women’s voice either before women enter marital partnerships or after (for instance, using health and social programming).

Evidence is needed in low- and middle-income countries regarding men's willingness to use new male contraceptive methods in development, preferences regarding method attributes, and what shapes willingness/preferences. We analyzed data from cross-sectional surveys with 611 men in Malawi, concerning willingness to use each of four types of new male methods. Mean age was 24.5 years; half (50 percent) were married/cohabiting. Over half (51 percent) of men expressed willingness to use at least one new male method, including a topical contraceptive gel (33 percent), injection (32 percent), pill (29 percent), and implant (14 percent). Many male product attributes were considered important (with 59-67 percent endorsement), including ease of use, comfort of use, side effects, partner approval, type of method, frequency of facility visits, and cost. A prevalent reported reason for willingness was to "share responsibility for family planning with my partner" (44 percent). In multivariate regression analyses, willingness was inversely associated with inequitable gender attitudes (p < 0.001) and was not associated with married/cohabiting status, using condoms, or perceived risk for HIV. These findings add to growing evidence that a majority of men express willingness to use new male contraceptive methods like a topical gel, injectable, or pill. Reflection around gender roles is likely critical within future education about male contraceptive methods.

This blog is part of a series in partnership with Population Council, Reproductive Health Supplies Coalition (RHSC), and Population Services International (PSI), to recognize World Contraception Day 2024.

Abstract Background HIV risk perception is an important cognition for prevention, theoretically engendering service-seeking and risk-reduction behaviors, but its composition remains poorly understood. We examined country-specific correlates of self-appraised HIV exposure risk among sexually active adolescent girls and young women (AGYW, aged 15–24 years) without HIV in Kenya, Malawi, and Zambia. We also explored overlaps between self-appraised HIV exposure risk and pre-exposure prophylaxis (PrEP) eligibility to identify engagement opportunities. Methods We analyzed cross-sectional data (2016/2017) to estimate sexual-related correlates of self-appraised HIV exposure risk (likely vs. not, temporally framed as “ever”) using log-Poisson models with robust standard errors. For sexual-related factors with an unadjusted p ≤ 0.10, individual adjusted models were fitted, controlling for sociodemographic and cognitive factors with an unadjusted p ≤ 0.10. PrEP eligibility was defined using national guidelines; since conditional criteria are in Malawi’s (age-disparate sex + ever-pregnant) and Zambia’s (multiple partners + condomless sex) guidelines, we also assessed PrEP eligibility after decoupling these factors. Results Few AGYW reported likely HIV exposures (Kenya [N = 746]: 15.7%, Malawi [N = 1348]: 46.2%, Zambia [N = 349]: 9.5%) despite ubiquitous HIV risk (98.7%, 99.8%, and 98.9% of Kenyan, Malawian, and Zambian AGYW reported ≥ 1 sexual-related factor). However, the adjusted models found some actual-perceived risk concordance. Positive correlates of self-appraised likely HIV exposures included partner(s)’ likely HIV exposure (all countries); partner(s)’ unknown HIV status and other partners (Kenya, Malawi); STI symptoms and partner(s) living outside the community (Kenya); non-partner sexual violence (Zambia); and transactional sex, multiple partners, pre-coital alcohol use, and physical/sexual intimate partner violence (Malawi). Per national guidelines, PrEP eligibility criteria differentially identified HIV risk (Kenya: 93.6%, Malawi: 53.3%, Zambia: 44.6%), and self-appraised likely HIV exposures were low among PrEP-eligible AGYW (Kenya: 16.5%, Malawi: 48.5%, Zambia: 18.8%). Decoupling Malawi’s and Zambia’s conditional PrEP criteria could increase risk identification to > 85% and potential engagement by ~ 70% and ~ 30%, respectively. Conclusions AGYW's HIV risk perceptions were mostly influenced by factors beyond their locus of control. Conditional PrEP eligibility criteria may inhibit AGYW’s access and uptake in some settings: countries should consider decoupling these factors to minimize barriers. Intersections between autonomy, behaviors, and perceptions among AGYW in gender-inequitable settings warrants further investigation.

Evidence is needed in low- and middle-income countries regarding men's willingness to use new male contraceptive methods in development, preferences regarding method attributes, and what shapes willingness/preferences. We analyzed data from cross-sectional surveys with 611 men in Malawi, concerning willingness to use each of four types of new male methods. Mean age was 24.5 years; half (50 percent) were married/cohabiting. Over half (51 percent) of men expressed willingness to use at least one new male method, including a topical contraceptive gel (33 percent), injection (32 percent), pill (29 percent), and implant (14 percent). Many male product attributes were considered important (with 59–67 percent endorsement), including ease of use, comfort of use, side effects, partner approval, type of method, frequency of facility visits, and cost. A prevalent reported reason for willingness was to “share responsibility for family planning with my partner” (44 percent). In multivariate regression analyses, willingness was inversely associated with inequitable gender attitudes ( p < 0.001) and was not associated with married/cohabiting status, using condoms, or perceived risk for HIV. These findings add to growing evidence that a majority of men express willingness to use new male contraceptive methods like a topical gel, injectable, or pill. Reflection around gender roles is likely critical within future education about male contraceptive methods.

A limited but growing body of literature shows that health care providers (HCPs) in reproductive, maternal, and newborn health face challenges that affect how they provide services. Our study investigates provider perspectives and behaviors using 4 interrelated power domains-beliefs and perceptions; practices and participation; access to assets; and structures-to explore how these constructs are differentially experienced based on one's gender, position, and function within the health system. We conducted a framework-based secondary analysis of qualitative in-depth interview data gathered with different cadres of HCPs across Kenya, Malawi, Madagascar, and Togo (n 1/4 123). We find across countries that power dynamics manifest in and are affected by all 4 domains, with some variation by HCP cadre and gender. At the service interface, HCPs' power derives from the nature and quality of their relationships with clients and the community. Providers' power within working relationships stems from unequal decision-making autonomy among HCP cadres. Limited and sometimes gendered access to remuneration, development opportunities, material resources, supervision quality, and emotional support affect HCPs' power to care for clients effectively. Power manifests variably among community and facility-based providers because of differences in prevailing hierarchical norms in routine and acute settings, community linkages, and type of collaboration required in their work. Our findings suggest that applying power-and secondarily, gender lensescan elucidate consistencies in how providers perceive, internalize, and react to a range of relational and environmental stressors. The findings also have implications on how to improve the design of social behavior change interventions aimed at better supporting HCPs.

Background: Health care provider behavior is the outcome of a complex set of factors that are both internal and external to the provider. Social and behavior change (SBC) programs are increasingly engaging providers and introducing strategies to improve their service delivery. However, there is limited understanding of methods and measures applied to assess provider behavioral outcomes and strengthen provider behavior change programming. Methods: Using PubMed, we conducted a rapid review of published research on behaviors of health workers providing reproductive, maternal, newborn, and child health services in lowand middle-income countries (2010-2021). Information on study identifiers (e.g., type of provider), select domains from Green and Kreuter's PRECEDE-PROCEED framework (e.g., predisposing factors such as attitudes), study characteristics (e.g., study type and design), and evidence of theory-driven research were extracted from a final sample of articles (N=89) and summarized. Results: More than 80% of articles were descriptive/formative and examined knowledge, attitudes, and practice, mostly related to family planning. Among the few evaluation studies, trainingfocused interventions to increase provider knowledge or improve competency in providing a health service were dominant. Research driven by behavioral theory was observed in only 3 studies. Most articles (75%) focused on the quality of client-provider interaction, though topics and modes of measurement varied widely. Very few studies incorporated a validated scale to measure underlying constructs, such as attitudes and beliefs, and how these may be associated with provider behaviors. Conclusion: A need exists for (1) theory-driven approaches to designing and measuring provider behavior change interventions and (2) measurement that addresses important internal and structural factors related to a provider's behavior (beyond knowledgeenhancing training approaches). Additional investment in implementation research is also needed to better understand which SBC approaches are shifting provider behavior and improving client-provider interactions. Finally, theory-driven approaches could help develop empirically measurable and comparable outcomes.

Presentation for AGYW & South-to-South Learning Network Champions to fill a knowledge gap about what strategies have been tested and found effective in low- and middle-income countries (LMICs) to prevent and respond to sexual violence experienced by adolescent girls and young women (AGYW). This topic was identified by East and Southern African Champions as a key impediment to their HIV prevention programming efforts. This review focused on evidence from all 15 South-to-South Learning Network (SSLN) countries to gather and synthesise contextually relevant information.