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Acceptability of a Tenofovir Disoproxil Fumarate Vaginal Ring for HIV Prevention Among Women in New York City

Abstract

Vaginal rings for pre-exposure prophylaxis are a female-initiated HIV prevention method that does not require daily or coitally-dependent dosing. As part of a randomized placebo-controlled trial of a tenofovir disoproxil fumarate intravaginal ring, we assessed product acceptability through in-depth interviews with 18 women during and after 14 days of continuous use. Women reported that the ring was comfortable with few side effects, regardless of experimental arm. However, interest in future use by this cohort was modest for several reasons including: low self-perceived HIV risk; concern that use implied promiscuity; potential for interference with relationship formation and trust; concern for interference with menstruation and cleanliness; and worries about partners’ acceptability and sexual pleasure. Potential issues were raised with duration of use prior to ring exchange. Future studies should continue to identify and address individual and relationship factors that influence acceptability, early in the product development process.

Resumen

Los anillos vaginales para la profilaxis preexposición (PrEP) son un método de prevención de VIH iniciado por mujeres que no requiere dosificación diaria o dependiente del coito. Como parte de un ensayo aleatorio controlado con placebo de un anillo intravaginal (IVR) de fumarato de disoproxilo de tenofovir (TDF), evaluamos la aceptabilidad del dispositivo a través de entrevistas en profundidad con 18 mujeres durante y después de 14 días de uso continuo. Las mujeres reportaron que el anillo era cómodo con pocos efectos secundarios, independiente del brazo experimental. Sin embargo, el interés en uso posterior por esta cohorte fue moderado por varias razones, incluyendo: autopercepción de bajo riesgo de VIH; preocupación de que el uso implica promiscuidad; potencial de interferencia con la formación de relaciones y la confianza; preocupación de interferencia con la menstruación y la limpieza; y preocupaciones sobre la aceptabilidad por parte del pareja y el placer sexual. Se plantearon cuestiones potenciales sobre la duración del uso antes del cambio de anillo. Los estudios futuros deben seguir identificando y abordando los factores individuales y de relación que influyen en la aceptabilidad en las primeras etapas del proceso de desarrollo del producto.

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Acknowledgements

The work was supported by Grants from the National Institutes of Health (AI076980, AI03461, TR001073) and by the Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI124414), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIMHD, NIGMS and NIDDK. We thank Lilia Espinoza and Dafna Rebibo for assisting with protocol development, participant recruitment, and field operations. We also acknowledge the site staff and study participants.

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Watnick, D., Keller, M.J., Stein, K. et al. Acceptability of a Tenofovir Disoproxil Fumarate Vaginal Ring for HIV Prevention Among Women in New York City. AIDS Behav 22, 421–436 (2018). https://doi.org/10.1007/s10461-017-1962-8

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Keywords

  • Vaginal ring
  • Acceptability
  • Pre-exposure prophylaxis
  • Women
  • HIV prevention