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The Influence of Perceived Dapivirine Vaginal Ring Effectiveness on Social Disclosure and Ring Adherence

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Abstract

We analyzed data from 1428 users of the dapivirine vaginal ring, who participated in the MTN-020/ASPIRE phase III trial and subsequent open-label extension MTN-025/HOPE trial, to examine relationships between perceived ring protection, social disclosures, and self-reported ring adherence. In HOPE, 77% perceived the ring to be highly effective, and this view was associated with speaking: (a) to a greater number of people about the study, (b) with other participants, (c) to more people who were in favor of the ring, and (d) to more people whose opinions were valued. Reported adherence was not directly associated with perceived protection but was associated with disclosing to someone who was in favor of the ring. These findings suggest the importance of women’s internalized ideas about the protective benefits of the DVR in sharing information about the ring and the importance of social support on adherence.

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Data Availability

Data are available through the Microbicide Prevention Trials Network.

Code Availability

Code for this project is available by contacting the corresponding author.

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Acknowledgements

ASPIRE/MTN-020 and HOPE/MTN-025 Study Team Leadership: Jared Baeten, University of Washington (Protocol Chair); Thesla Palanee-Phillips, Wits Reproductive Health and HIV Institute (Protocol Co-chair); Nyaradzo Mgodi, University of Zimbabwe College of Health Sciences Clinical Trials Unit (Protocol Co-chair); Elizabeth Brown, Fred Hutchinson Cancer Research Center (Protocol Statistician); Lydia Soto-Torres, US National Institute of Allergy and Infectious Diseases (Medical Officer); Katie Schwartz, FHI 360 (Clinical Research Manager), Ashley Mayo, FHI 360 (Clinical Research Manager).

ASPIRE/MTN-020 and HOPE/MTN-025 Study sites and site Investigators of Record: Malawi, Blantyre site (Johns Hopkins University, Queen Elizabeth Hospital): Bonus Makanani; Malawi, Lilongwe site (University of North Carolina, Chapel Hill): Francis Martinson, Lameck Chinula; South Africa, Cape Town site (University of Cape Town): Linda-Gail Bekker, Gonasagrie Nair; South Africa, Durban – Botha’s Hill, Chatsworth, Isipingo, Tongaat, Umkomaas, Verulam sites (South African Medical Research Council): Vaneshree Govender, Samantha Siva, Zakir Gaffoor, Logashvari Naidoo, Arendevi Pather, Nitesha Jeenarain, Gita Ramjee, Dishiki Kalonji, and Nishanta Singh; South Africa, Durban, eThekwini site (Center for the AIDS Programme for Research in South Africa): Gonasagrie Nair, Leila Mansoor; South Africa, Johannesburg site (Wits RHI): Thesla Palanee-Phillips; Uganda, Kampala site (John Hopkins University, Makerere University): Flavia Matovu, Brenda Gati; Zimbabwe, Chitungwiza and Harare—Zengeza, Seke South and Splihaus sites (University of Zimbabwe Clinical Trials Research Centre): Nyaradzo Mgodi, Portia Hunidzarira, and Felix Mhlanga.

Data management was provided by The Statistical Center for HIV/AIDS Research & Prevention (Fred Hutchinson Cancer Research Center, Seattle, WA) and site laboratory oversight was provided by the Microbicide Trials Network Laboratory Center (Pittsburgh, PA). The vaginal rings used in this study were developed and supplied by the International Partnership for Microbicides (IPM).

Jared Baeten, Thesla Palanee-Phillips, Nyaradzo Mgodi, Elizabeth Brown, Lydia Soto-Torres, Katie Schwartz, Ashley Mayo, Bonus Makanani, Francis Martinson, Lameck Chinula, Linda-Gail Bekker, Gonasagrie Nair, Vaneshree Govender, Samantha Siva, Zakir Gaffoor, Logashvari Naidoo, Arendevi Pather, Nitesha Jeenarain, Gita Ramjee, Dishiki Kalonji, Nishanta Singh, Leila Mansoor, Flavia Matovu, Brenda Gati, Portia Hunidzarira, and Felix Mhlanga.

Funding

The Microbicide Trials Network is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, 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. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We thank the study participants as well as the ASPIRE/HOPE Study team members who implemented the trials.

Author information

Authors and Affiliations

  1. Women’s Global Health Imperative, RTI International, 2150 Shattuck avenue, Berkeley, CA, USA

    Marie C. D. Stoner & Ariane van der Straten

  2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Elizabeth R. Brown

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Elizabeth R. Brown

  4. Center for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa

    Leila E. Mansoor

  5. Wits Reproductive Health and HIV Institute, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa

    Thesla Palanee-Phillips

  6. University of North Carolina Project Malawi, Lilongwe, Malawi

    Tchangani Tembo

  7. Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa

    Gonasagrie Nair

  8. Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda

    Carolyne Akello

  9. Malawi College of Medicine-John Hopkins University Research Project, Blantyre, Malawi

    Linly Seyama

  10. South African Medical Research Council, Durban, South Africa

    Nitesha Jeenarain & Logashvari Naidoo

  11. University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe

    Nyaradzo Mgodi, Portia Hunidzarira & Miria Chitukuta

  12. Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA

    Ariane van der Straten

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  1. Marie C. D. Stoner
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Consortia

for the MTN-020 ASPIRE and M-025 HOPE study teams

  • Jared Baeten
  • , Thesla Palanee-Phillips
  • , Nyaradzo Mgodi
  • , Elizabeth Brown
  • , Lydia Soto-Torres
  • , Katie Schwartz
  • , Ashley Mayo
  • , Bonus Makanani
  • , Francis Martinson
  • , Lameck Chinula
  • , Linda-Gail Bekker
  • , Gonasagrie Nair
  • , Vaneshree Govender
  • , Samantha Siva
  • , Zakir Gaffoor
  • , Logashvari Naidoo
  • , Arendevi Pather
  • , Nitesha Jeenarain
  • , Gita Ramjee
  • , Dishiki Kalonji
  • , Nishanta Singh
  • , Leila Mansoor
  • , Flavia Matovu
  • , Brenda Gati
  • , Portia Hunidzarira
  •  & Felix Mhlanga

Contributions

MCDS, AvdS contributed to the conception, design of the analysis and writing of the paper. E.B. provided statistical support on the analysis. The remaining authors were involved in data acquisition, data collection, study management and design of the original parent study. All authors have reviewed the paper, provided comments and edits to the manuscript and have read and approved the final manuscript.

Corresponding author

Correspondence to Marie C. D. Stoner.

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Conflict of interest

We declare no competing interests.

Consent to Participate

All participants provided written informed consent.

Ethical Approval

The trial protocol was approved by the ethics review committee at each site.

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Appendix

Appendix

See Tables 5 and 6.

Table 5 Characteristics of social disclosures in ASPIRE versus the HOPE trials (N = 7160 possible disclosures reported, up to 5 per person)
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Table 6 Characteristics of social disclosures in HOPE (N = 7160 possible disclosures reported, up to 5 per person) by if the disclosure was in favor of the ring
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Stoner, M.C.D., Brown, E.R., Palanee-Phillips, T. et al. The Influence of Perceived Dapivirine Vaginal Ring Effectiveness on Social Disclosure and Ring Adherence. AIDS Behav 25, 4169–4179 (2021). https://doi.org/10.1007/s10461-021-03286-w

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