{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:50:51Z","timestamp":1780098651983,"version":"3.54.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID-OAA-A-16-00032"],"award-info":[{"award-number":["AID-OAA-A-16-00032"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>With newer advances in HIV biomedical research, the prevention toolbox is expanding with potential inclusion of long-acting anti-retrovirals, broadly neutralizing antibodies (bNAbs), and vaccines. While a multitude of prevention options provide diverse choice sets, they may potentially introduce conundrums and trade-offs which influence end-user decisions on acceptability. Thus, to maximize the unique value and uptake of new products, it is critical to understand contextual drivers of choice and relative product positioning. With HIV bNAbs in the pipeline, a qualitative study was conducted to understand end-users\u2019 acceptability. 36 focus-group discussions (n=242) and 57 in-depth interviews were conducted in Chennai, Delhi and Mumbai, with female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and transgender women (TGW) and adolescent girls and young women (AGYW). In addition, 15 simulated behavioral experiments (n=94) were conducted to delve deeper into factors influencing decision-making and potential avenues for intention-action gaps to understand preference construction and reversal pathways. Efficacy, frequency of administration and side-effects were the most important attributes driving acceptability. At least 70% to 90% efficacy was preferred. Arm was the most preferred site of administration (familiarity, maximum privacy), whereas buttocks were preferred by some (better pain tolerance, unhampered mobility). One injection every 3\u20136 months from community-based facilities was most preferred. Most did not favor self-administration (lack of self-efficacy, adverse events) and voiced confidence in community-friendly professionals. Concerns were raised about potential major side-effects such as interactions with co-morbidities, fertility, pregnancy, gender-affirmation therapy, physical appearance. When end-users were presented with hypothetical product profiles, all preferred the non-antiretroviral (non-ARV) based option which had arm as site of injection and administered every three months by healthcare workers. The preference construction journey revealed positive emotions and rational considerations which favoured bNAbs use but they were contrasted with negative emotions and rationale which hindered acceptability, and the users were faced with multiple conundrums. Some of these conundrums gave rise to potential scenarios of preference reversal.<\/jats:p>","DOI":"10.1371\/journal.pone.0321725","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T17:47:26Z","timestamp":1745257646000},"page":"e0321725","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acceptability of broadly neutralizing antibodies (bNAbs) for HIV prevention among vulnerable populations in India: Findings from a qualitative study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5018-2736","authenticated-orcid":true,"given":"Joyeeta","family":"Mukherjee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"ul Hadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesan","family":"Chakrapani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruta","family":"Rawat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aylur Kailasom","family":"Srikrishnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaishali","family":"Mahendra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dicky","family":"Baruah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shobha","family":"Mohapatra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Gopinath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpana","family":"Dange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratyasha","family":"Rath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pallavi","family":"Manchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3908-8463","authenticated-orcid":true,"given":"Alok","family":"Gangaramany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pritha","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly","family":"Malhotra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Keane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajat","family":"Goyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"key":"pone.0321725.ref001","author":"Global HIV and AIDS fact sheet"},{"key":"pone.0321725.ref002","author":"HIV and AIDS fact sheet","year":"2022"},{"issue":"1","key":"pone.0321725.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJMp1916753","article-title":"Four decades of HIV\/AIDS - Much accomplished, much to do","volume":"383","author":"AS Fauci","year":"2020","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0321725.ref004","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1038\/nm.4268","article-title":"Antibody 10-1074 suppresses viremia in HIV-1-infected individuals","volume":"23","author":"M Caskey","year":"2017","journal-title":"Nat Med"},{"issue":"3","key":"pone.0321725.ref005","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.cell.2020.01.010","article-title":"Restriction of HIV-1 escape by a highly broad and potent neutralizing antibody","volume":"180","author":"P Schommers","year":"2020","journal-title":"Cell"},{"key":"pone.0321725.ref006"},{"key":"pone.0321725.ref007","author":"National AIDS Control Organization (NACO).","year":"2017"},{"key":"pone.0321725.ref008","author":"National Family Health Survey","year":"2015\u201316"},{"key":"pone.0321725.ref009","author":"Youth Unite for Victory on AIDS (YUVA)."},{"key":"pone.0321725.ref010"},{"issue":"6","key":"pone.0321725.ref011","doi-asserted-by":"crossref","first-page":"93","DOI":"10.52403\/ijhsr.20230616","article-title":"Identifying hotspots of HIV infection in India","volume":"13","author":"PK Chokhandre","year":"2023","journal-title":"Int J Health Sci Res"},{"issue":"2","key":"pone.0321725.ref012","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s40271-020-00486-9","article-title":"Eliciting preferences for HIV prevention technologies: A systematic review","volume":"14","author":"SW Beckham","year":"2021","journal-title":"Patient"},{"issue":"1","key":"pone.0321725.ref013","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S1473-3099(12)70273-6","article-title":"Combination implementation for HIV prevention: Moving from clinical trial evidence to population-level effects","volume":"13","author":"LW Chang","year":"2013","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pone.0321725.ref014","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1186\/s12889-020-09785-0","article-title":"Willingness to use HIV prevention methods among vaccine efficacy trial participants in Soweto, South Africa: Discretion is important","volume":"20","author":"F Laher","year":"2020","journal-title":"BMC Public Health"},{"issue":"9","key":"pone.0321725.ref015","doi-asserted-by":"crossref","first-page":"e1004102","DOI":"10.1371\/journal.pmed.1004102","article-title":"HIV prevention for the next decade: Appropriate, person-centred, prioritised, effective, combination prevention","volume":"19","author":"(on behalf of the 2025 prevention targets working group)","year":"2022","journal-title":"PLoS Med"},{"issue":"1","key":"pone.0321725.ref016","doi-asserted-by":"crossref","first-page":"22252","DOI":"10.1038\/s41598-021-01634-3","article-title":"Preferences regarding emerging HIV prevention technologies among Toronto men who have sex with men: A discrete choice experiment","volume":"11","author":"DHS Tan","year":"2021","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0321725.ref017","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1097\/QAI.0000000000002670","article-title":"Long-acting injection and implant preferences and trade-offs for HIV prevention among South African male youth","volume":"87","author":"ET Montgomery","year":"2021","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"7","key":"pone.0321725.ref018","doi-asserted-by":"crossref","first-page":"e0181411","DOI":"10.1371\/journal.pone.0181411","article-title":"Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe","volume":"12","author":"SK Sgaier","year":"2017","journal-title":"PLoS One"},{"key":"pone.0321725.ref019","doi-asserted-by":"crossref","first-page":"120p","DOI":"10.1037\/0000224-000","volume-title":"Essentials of descriptive and interpretive qualitative research: A generic approach","author":"R Elliott","year":"2021"},{"key":"pone.0321725.ref020","article-title":"Qualitative research & evaluation methods: Integrating theory and practice","author":"MQ Patton","year":"2015"},{"issue":"4","key":"pone.0321725.ref021","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: Exploring its conceptualization and operationalization","volume":"52","author":"B Saunders","year":"2018","journal-title":"Qual Quant"},{"issue":"Suppl 3","key":"pone.0321725.ref022","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/hec.3629","article-title":"Behavioural experiments in health: An introduction","volume":"26","author":"MM Galizzi","year":"2017","journal-title":"Health Econ"},{"key":"pone.0321725.ref023","doi-asserted-by":"crossref","first-page":"e47700","DOI":"10.2196\/47700","article-title":"Understanding the acceptability of broadly neutralizing antibodies for HIV prevention among at-risk populations and feasibility considerations for product introduction in India: Protocol for a qualitative study","volume":"13","author":"J Mukherjee","year":"2024","journal-title":"JMIR Res Protoc"},{"issue":"6","key":"pone.0321725.ref024","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/COH.0b013e3283590632","article-title":"Acceptability in microbicide and PrEP trials: Current status and a reconceptualization","volume":"7","author":"BS Mensch","year":"2012","journal-title":"Curr Opin HIV AIDS"},{"issue":"1","key":"pone.0321725.ref025","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s12913-017-2031-8","article-title":"Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework","volume":"17","author":"M Sekhon","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"pone.0321725.ref026","volume-title":"The discovery of grounded theory: Strategies for qualitative research","author":"B Glaser","year":"1967"},{"key":"pone.0321725.ref027","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4899-1939-7_11","article-title":"The analysis of emotions","volume-title":"In: What develops in emotional development?","author":"NH Frijda","year":"1998"},{"issue":"2","key":"pone.0321725.ref028","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1002\/wcs.98","article-title":"Values and preferences: defining preference construction","volume":"2","author":"C Warren","year":"2011","journal-title":"Wiley Interdiscip Rev Cogn Sci"},{"issue":"4","key":"pone.0321725.ref029","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/QAI.0000000000001945","article-title":"Young women\u2019s stated preferences for biomedical HIV Prevention: Results of a discrete choice experiment in Kenya and South Africa","volume":"80","author":"AM Minnis","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0321725.ref030","article-title":"Preferred product attributes of a multipurpose vaginal ring: Findings from a phase 1 trial","volume":"5","author":"EE Tolley","journal-title":"Front Reprod Health"},{"key":"pone.0321725.ref031","doi-asserted-by":"crossref","first-page":"1156864","DOI":"10.3389\/frph.2023.1156864","article-title":"Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: A scoping review","volume":"5","author":"NL Bhushan","year":"2023","journal-title":"Front Reprod Health"},{"issue":"7","key":"pone.0321725.ref032","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1007\/s10461-016-1370-5","article-title":"Familiarity with and preferences for oral and long-acting injectable HIV Pre-exposure Prophylaxis (PrEP) in a national sample of gay and bisexual men in the U.S","volume":"20","author":"JT Parsons","year":"2016","journal-title":"AIDS Behav"},{"issue":"8","key":"pone.0321725.ref033","doi-asserted-by":"crossref","first-page":"2662","DOI":"10.1007\/s10461-018-2078-5","article-title":"Young women\u2019s ratings of three placebo multipurpose prevention technologies for HIV and pregnancy prevention in a randomized, cross-over study in Kenya and South Africa","volume":"22","author":"AM Minnis","year":"2018","journal-title":"AIDS Behav"},{"issue":"5","key":"pone.0321725.ref034","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1007\/s10461-019-02715-1","article-title":"Efficacy is not everything: Eliciting women\u2019s preferences for a vaginal HIV prevention product using a discrete-choice experiment","volume":"24","author":"EN Browne","year":"2020","journal-title":"AIDS Behav"},{"issue":"13","key":"pone.0321725.ref035","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1056\/NEJMoa2407001","article-title":"Twice-yearly lenacapavir or daily F\/TAF for HIV prevention in cisgender women","volume":"391","author":"LG Bekker","year":"2024","journal-title":"N Engl J Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321725","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T17:47:39Z","timestamp":1745257659000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321725"}},"subtitle":[],"editor":[{"given":"Manish","family":"Sagar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,21]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0321725","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,21]]}}}