“…this could be a noble idea and a game changer.” The potential of a dual prevention pill for HIV and pregnancy prevention among adolescent girls and young women in Zimbabwe

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.