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The Power of the Shared Experience: MTN-020/ASPIRE Trial Participants’ Descriptions of Peer Influence on Acceptability of and Adherence to the Dapivirine Vaginal Ring for HIV Prevention

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Abstract

Women are disproportionately at risk of acquiring HIV in East and Southern Africa, despite global declines in incidence. Female-initiated HIV prevention methods, like the dapivirine vaginal ring, are needed to end the HIV epidemic. In-depth interviews and focus groups retrospectively explored peer influence on acceptability of and adherence to the ring during the ASPIRE trial, a phase III placebo-controlled trial. Results were analyzed using an inductive analytic approach. Study participants (peers) of all ages and adherence groups developed important interpersonal connections and reported being more open and honest with each other than with external peers or study staff. Study peers who knew each other prior to joining appeared to have a stronger influence on each other’s adherence than peers who met in the study. External peers provided primarily negative input about the ring and study, which sometimes led to ring removals. Peers’ influence on each other’s behavior in both prosocial and detrimental manners could have repercussions on adherence to a biomedical intervention, and consequently, individual disease risk and clinical trial outcomes. Future ring demonstration and implementation studies could use peer networks to intentionally influence uptake and adherence to the ring.

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References

  1. UNAIDS. Global HIV & AIDS Statistics—2018 fact sheet: UNAIDS;2018.

  2. O'Leary A. Women and HIV in the twenty-first century: how can we reach the UN 2030 goal? AIDS Educ Prev. 2018;30(3):213–24.

    PubMed  Google Scholar 

  3. Baeten JM, Haberer JE, Liu AY, Sista N. Preexposure prophylaxis for HIV prevention: where have we been and where are we going? J Acquir Immune Defic Syndr. 2013;63:S122–S129129.

    PubMed  PubMed Central  Google Scholar 

  4. Marrazzo JM, Ramjee G, Richardson BA, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–18.

    PubMed  PubMed Central  Google Scholar 

  5. Van Damme L, Corneli A, Ahmed K, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.

    PubMed  PubMed Central  Google Scholar 

  6. Celum CL, Delany S, Baeten JM, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(Suppl 4):e25298.

    PubMed  PubMed Central  Google Scholar 

  7. Amico KR, Mansoor LE, Corneli A, Torjesen K, van der Straten A. Adherence support approaches in biomedical HIV prevention trials: experiences, insights and future directions from four multisite prevention trials. AIDS Behav. 2013;17(6):2143–55.

    PubMed  PubMed Central  Google Scholar 

  8. Corneli AL, McKenna K, Headley J, et al. A descriptive analysis of perceptions of HIV risk and worry about acquiring HIV among FEM-PrEP participants who seroconverted in Bondo, Kenya, and Pretoria, South Africa. J Int AIDS Soc. 2014;17(3S2):19152.

    PubMed  PubMed Central  Google Scholar 

  9. van der Straten A, Montgomery ET, Musara P, et al. Disclosure of pharmacokinetic drug results to understand nonadherence. AIDS. 2015;29(16):2161–71.

    PubMed  Google Scholar 

  10. Montgomery ET, Mensch B, Musara P, et al. Misreporting of product adherence in the MTN-003/VOICE trial for HIV prevention in Africa: participants' explanations for dishonesty. AIDS Behav. 2017;21(2):481–91.

    PubMed  PubMed Central  Google Scholar 

  11. van der Straten A, Stadler J, Montgomery E, et al. Women's experiences with oral and vaginal pre-exposure prophylaxis: the VOICE-C qualitative study in Johannesburg, South Africa. PLoS ONE. 2014;9(2):e89118.

    PubMed  PubMed Central  Google Scholar 

  12. Reid A. More investment needed in developing female-controlled HIV prevention options: UNAIDS; 2016.

  13. van de Wijgert J. Working towards HIV prevention choices for women. The lancet. 2018;5(2):e60–e61.

    PubMed  Google Scholar 

  14. AVAC. Tracking the fast-changing status of PrEP around the world. 2018. https://www.avac.org/blog/tracking-prep-status. Accessed 12 Nov 2018

  15. Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.

    CAS  PubMed  Google Scholar 

  16. Celum C, Baeten JM. Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence. Curr Opin Infect Dis. 2012;25(1):51–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Seltzer H, Solai, L. IPM’s Application for dapivirine vaginal ring for reducing HIV risk in women now under review by european medicines agency: international partnership for microbicides; 2017.

  18. Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Nel A, Bekker L-G, Bukusi E, et al. Safety, acceptability and adherence of dapivirine vaginal ring in a microbicide clinical trial conducted in multiple countries in Sub-Saharan Africa. PLoS ONE. 2016;11(3):e0147743.

    PubMed  PubMed Central  Google Scholar 

  20. Brown E, Palanee-Philips T, Marzinke M, et al. Residual dapivirine ring levels indicate higher adherence to vaginal ring is associated with HIV-1 protection. Paper presented at Journal of the International Aids Society; 2016.

  21. Montgomery ET, van der Straten A, Chitukuta M, et al. Acceptability and use of a dapivirine vaginal ring in a phase III trial. Aids. 2017;31(8):1159–67.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Montgomery ET, Stadler J, Naidoo S, et al. Reasons for nonadherence to the dapivirine vaginal ring. Aids. 2018;32(11):1517–25.

    CAS  PubMed  Google Scholar 

  23. Albert D, Chein J, Steinberg L. Peer influences on adolescent decision making. Curr Directions Psychol Sci. 2013;22(2):114–20.

    Google Scholar 

  24. Okonkwo PI, Fatusi AO, Ilika AL. Perception of peers' behaviour regarding sexual health decision making among female undergraduates in Anambra State. Nigeria. Afr Health Sci. 2005;5(2):107–13.

    CAS  PubMed  Google Scholar 

  25. Tome G, Matos M, Simoes C, Diniz JA, Camacho I. How can peer group influence the behavior of adolescents: explanatory model. Glob J Health Sci. 2012;4(2):26–35.

    PubMed  PubMed Central  Google Scholar 

  26. Neary J, Wagner AD, Mugo C, et al. Influence and involvement of support people in adolescent and young adult HIV testing. AIDS Care. 2019;31(1):105–12.

    PubMed  Google Scholar 

  27. Kanda L, Mash R. Reasons for inconsistent condom use by young adults in Mahalapye, Botswana. Afr J Primary Health Care Fam Med. 2018;10(1):e1–e7.

    Google Scholar 

  28. Chitukuta M, Duby Z, Katz A, et al. Negative rumours about a vaginal ring for HIV-1 prevention in sub-Saharan Africa. Cult Health Sex. 2019;21(11):1209–24.

    PubMed  Google Scholar 

  29. Duby Z, Katz A, Musara P, et al. "The state of mind tells me it's dirty": menstrual shame amongst women using a vaginal ring in Sub Saharan Africa. Women Health. 2019;60(1):72–86.

    PubMed  Google Scholar 

  30. Duby Z, Katz AWK, Browne EN, et al. Hygiene, blood flow, and vaginal overload: why women removed an HIV prevention vaginal ring during menstruation in Malawi, South Africa, Uganda and Zimbabwe. AIDS Behav; 2019.

  31. Pleasants E, Tauya T, Reddy K, et al. Relationship type and use of the vaginal ring for HIV-1 prevention in the MTN 020/ASPIRE trial. AIDS Behav; 2019.

  32. Laborde ND, Pleasants E, Reddy K, et al. Impact of the dapivirine vaginal ring on sexual experiences and intimate partnerships of women in an HIV prevention clinical trial: managing ring detection and hot sex. AIDS Behav. 2018;22(2):437–46.

    PubMed  PubMed Central  Google Scholar 

  33. Palanee-Phillips T, Schwartz K, Brown ER, et al. Characteristics of women enrolled into a randomized clinical trial of dapivirine vaginal ring for HIV-1 prevention. PLoS ONE. 2015;10(6):e0128857.

    PubMed  PubMed Central  Google Scholar 

  34. Schwartz K, Ndase P, Torjesen K, et al. Supporting participant adherence through structured engagement activities in the MTN-020 (ASPIRE) trial. AIDS Res Hum Retroviruses. 2014;30(S1):A80–A8080.

    Google Scholar 

  35. Fearon E, Wiggins RD, Pettifor AE, Hargreaves JR. Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review. Soc Sci Med. 2015;146:62–74.

    PubMed  Google Scholar 

  36. Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237–46.

    Google Scholar 

  37. Katz J. Analytic Induction. In: Smelser NJ, Baltes PB, editors. International encyclopedia of the social & behavioral sciences. Oxford: Pergamon; 2001. p. 480–484.

    Google Scholar 

  38. Bhattacharya K. Fundamentals of qualitative research: a practical guide. London: Routledge; 2017.

    Google Scholar 

  39. Magazi B, Stadler J, Delany-Moretlwe S, et al. Influences on visit retention in clinical trials: insights from qualitative research during the VOICE trial in Johannesburg South Africa. BMC Women's Health. 2014;14:88–88.

    PubMed  PubMed Central  Google Scholar 

  40. van der Straten A, Browne EN, Shapley-Quinn MK, et al. First impressions matter: how initial worries influence adherence to the dapivirine vaginal ring. J Acquir Immune Defic Syndr. 2019;81(3):304–10.

    PubMed  PubMed Central  Google Scholar 

  41. Ramchand R, Ahluwalia SC, Xenakis L, Apaydin E, Raaen L, Grimm G. A systematic review of peer-supported interventions for health promotion and disease prevention. Prev Med. 2017;101:156–70.

    PubMed  Google Scholar 

  42. Morar NS, Naidoo S, Goolam A, Ramjee G. Research participants' skills development as HIV prevention peer educators in their communities. J Health Psychol. 2018;23(10):1343–9.

    PubMed  Google Scholar 

  43. Naidoo S, Morar NS, Ramjee G. Participants as community-based peer educators: impact on a clinical trial site in KwaZulu-Natal. S Afr J Sci. 2013;109(7–8):01–5.

    Google Scholar 

  44. Aronson E. The social animal. New York: Worth Publishers; 2004.

    Google Scholar 

  45. Hocevar KP, Metzger M, Flanagin AJ. Source credibility, expertise, and trust in health and risk messaging. Oxford: Oxford University Press; 2017.

    Google Scholar 

  46. Anderson N, Steinauer J, Valente T, Koblentz J, Dehlendorf C. Women's social communication about IUDs: a qualitative analysis. Perspect Sex Reprod Health. 2014;46(3):141–8.

    PubMed  PubMed Central  Google Scholar 

  47. Hoopes AJ, Gilmore K, Cady J, Akers AY, Ahrens KR. A qualitative study of factors that influence contraceptive choice among adolescent school-based health center patients. J Pediatr Adolesc Gynecol. 2016;29(3):259–64.

    PubMed  Google Scholar 

  48. Yee L, Simon M. The role of the social network in contraceptive decision-making among young, African American and Latina women. J Adolesc health. 2010;47(4):374–80.

    PubMed  PubMed Central  Google Scholar 

  49. Oster E, Thornton R. Determinants of technology adoption: peer effects in menstrual cup take-up. J Eur Econ Assoc. 2012;10(6):1263–93.

    Google Scholar 

  50. Kincaid DL. Social networks, ideation, and contraceptive behavior in Bangladesh: a longitudinal analysis. Soc Sci Med. 2000;50(2):215–31.

    CAS  PubMed  Google Scholar 

  51. Beniamino C, Holly S. Social norms and adolescents' sexual health: an introduction for practitioners working in low and mid-income African countries. Afr J Reprod Health. 2018;22(1):38–46.

    PubMed Central  Google Scholar 

  52. Closson K, Dietrich JJ, Lachowsky NJ, et al. Sexual self-efficacy and gender: a review of condom use and sexual negotiation among young men and women in sub-saharan Africa. J Sex Res. 2018;55(4–5):522–39.

    PubMed  Google Scholar 

  53. Romer D, Black M, Ricardo I, et al. Social influences on the sexual behavior of youth at risk for HIV exposure. Am J Public Health. 1994;84(6):977–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Kim J. The effect of peers on HIV infection expectations among Malawian adolescents: using an instrumental variables/school fixed effect approach. Soc Sci Med. 1982;2016(152):61–9.

    Google Scholar 

  55. Ball K, Jeffery RW, Abbott G, McNaughton SA, Crawford D. Is healthy behavior contagious: associations of social norms with physical activity and healthy eating. Int J Behav Nutr Phys activity. 2010;7:86–86.

    Google Scholar 

  56. Sheehan DM, Miller RP, Trepka MJ, Smith LR, Latkin C. Role of social network sexual norms and behaviors on the HIV sexual risk behaviors of people who inject drugs in HPTN 037. AIDS Behav. 2019;23(6):1604–11.

    PubMed  PubMed Central  Google Scholar 

  57. Latkin CA, Knowlton AR. Micro-social structural approaches to HIV prevention: a social ecological perspective. AIDS Care. 2005;17(Suppl 1):S102–113.

    PubMed  Google Scholar 

  58. Berkowitz AD. The social norms approach: theory, research, and annotated bibliography. 2004.

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Acknowledgements

We would like to thank AHA participants for their contribution to this research. The Microbicide Trials Network (MTN) leadership and operating center, FHI 360, and MTN-032 Protocol study team members are acknowledged as critical in the development, implementation, and/or analysis of this study. The full MTN-032 study team can be viewed at https://mtnstopshiv.org/research/studies/mtn-032. This paper benefited greatly from the contributions of Ariane van der Straten for review of and contributions to earlier versions of this manuscript. The study was designed and implemented by the MTN funded by the National Institute of Allergy and Infectious Diseases through individual grants (UM1AI068633, UM1AI068615 and UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Women’s Global Health Imperative, RTI International, 351 California St, Suite 500, San Francisco, CA, 94104, USA

    Ariana W. K. Katz & E. T. Montgomery

  2. Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa

    K. Naidoo

  3. Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa

    K. Reddy

  4. University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe

    M. Chitukuta

  5. Makerere University-Johns Hopkins University Research Unit, Kampala, Uganda

    J. Nabukeera

  6. HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa

    S. Siva

  7. University of North Carolina (UNC) Project-Lilongwe, Tidziwe Center, P/Bag A104, Lilongwe, Malawi

    C. Zimba

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  1. Ariana W. K. Katz
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Correspondence to Ariana W. K. Katz.

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Katz, A.W.K., Naidoo, K., Reddy, K. et al. The Power of the Shared Experience: MTN-020/ASPIRE Trial Participants’ Descriptions of Peer Influence on Acceptability of and Adherence to the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav 24, 2387–2399 (2020). https://doi.org/10.1007/s10461-020-02799-0

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