Adolescent views on participating in HIV biomedical research during pregnancy: a qualitative analysis of motivators and barriers

Pregnant adolescents are often excluded from biomedical HIV research participation, resulting in less evidence to inform safe and effective treatment and prevention strategies. We explored adolescent views on enrollment in biomedical HIV research during pregnancy via in-depth interviews with ever-pregnant adolescents living with and at-risk of HIV age 15-20 years in Botswana and Malawi. A semi-structured interview guide explored decision-making around study enrollment during pregnancy using vignettes depicting two hypothetical HIV studies: (1) testing pregnancy-specific dosage of an HIV medication, and (2) a randomized control trial comparing an oral regimen to a new injectable. Audio-recorded interviews were transcribed, translated to English, coded in NVivo, and thematically analyzed for emergent themes in participation motivators/barriers. Of the 80 adolescents interviewed (40 living with and 40 at-risk of HIV), 73 (91.3%) were interested in joining vignette study 1 and 65 (81.3%) in vignette 2. Participation motivators included treating/preventing HIV<u>,</u> gaining health knowledge, and helping others. Barriers included study participation requirements, the studies' experimental nature, and randomization. Adolescents' high interest in and reasons for participation during pregnancy suggest their exclusion from biomedical HIV research may be inconsistent with their views, interests, and capacities, providing important considerations for ethical and inclusive study design.