I used VS2019 to create a 32-bit .ocx control (MFCActiveX). I added the control to a .Net Framework Winforms project using VS2019. The I copied the Winforms project and the 32-bit .ocx control to a different VM that has VS2022 17.9 installed.
I registered the 32-bit .ocx control with regsvr32.exe and using notepad added the following line to the Winforms project properties.
<UseWinFormsOutOfProcDesigner>True</UseWinFormsOutOfProcDesigner>
This project property was discussed in the .Net blog article WinForms Designer Selection for 32-bit .NET Framework Projects. I added this to the .csproj for the Winforms project BEFORE I opened it in VS2022.
The project opened and the out-of-process designer loaded my test form with the 32-bit .ocx on it.

And the same solution works just as well in a VB .Net Framework Winforms project --
