Theory-driven formative research to support development of a pre-exposure prophylaxis (PrEP) demand creation campaign among young women in a South-African township

Background: HIV pre-exposure prophylaxis (PrEP) is highly effective and could reduce the persistent high HIV incidence among young South African women. Demand creation is needed to increase PrEP uptake of this novel prevention technology. Theoretically-grounded formative research (FR) could identify factors to include in a demand creation campaign to motivate young South African women to seek PrEP. Methods: Thirty-four household visits with young women (aged 16–32) were conducted in a township near Cape Town using Behavior Centered Design (BCD), investigating behavior contexts, the social and family environments and psychological processes, using qualitative and interactive tools, such as forced choice dilemmas, ranking games, daily script elicitation and network- and community drawings. Results: The FR generated findings concerning a wide variety of topic areas and identified a range of opportunities as well as challenges for the successful implementation of PrEP promotion in this population. Potential challenges were young women underestimating the consequences of acquiring HIV; taking medicine to prevent a disease (which was an unfamiliar concept) and young women having few responsibilities, making health care seeking and daily pill-taking with PrEP challenging. Potential opportunities that could be leveraged for PrEP demand creation were young women’s desire for trust and emotional closeness in relationships and the limited existing roles for young women, which could provide room for creating new aspirational roles that would motivate young women to take PrEP. Conclusion: A theory-based and context-specific approach to FR led to a broad understanding of the lives and influences on young South African women and generated a comprehensive set of opportunities for intervention.