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Preferences and Acceptability of Vaginal Delivery Forms for HIV Prevention Among Women, Male Partners and Key Informants in South Africa and Zimbabwe: Qualitative Findings

AIDS and Behavior volume 25, pages 124–138 (2021)Cite this article

Abstract

The attributes of an HIV microbicide may affect its acceptability, uptake and use. Quatro, a clinical study with a qualitative component, was conducted to elicit input from end-users and key informants (KIs) on four different placebo vaginal microbicide delivery forms; fast dissolving insert, ring, film and gel. In-depth interviews and focus group discussions were conducted with young women, their male partners and KIs, to explore acceptability and preferences of the four placebo products, with the intention of improving product attributes, adherence, and consequently, long term effectiveness. None of the four microbicide delivery forms stood well above others as the most preferred. Product attributes; long-action, ease of use, invisibility, female initiated and non-interference during sex were favourable in both countries. Despite preference for the long-action, on-demand products were the most liked by women. Qualitative data from the Quatro study provided rich feedback on specific attributes important to the acceptability of four HIV prevention product platforms currently in development, enabling more informed and guided product development efforts moving forward.

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References

  1. Joint united nations programme on HIV/AIDS. The Gap Report. Geneva: UNAIDS. 2014. 30–37. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf.

  2. 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.

    Article  CAS  Google Scholar 

  3. Nel A, van Niekerk N, Kapiga S, et al. Safety and efficacy of a dapivirine vaginal ring for hiv prevention in women. N Engl J Med. 2016;375(22):2133–43. https://doi.org/10.1056/NEJMoa1602046.

    Article  CAS  PubMed  Google Scholar 

  4. https://mtnstopshiv.org Accessed 30 April 2019.

  5. https://hptn.org Accessed 30 April 2019.

  6. Dai JY, Gilbert PB, Hughes JP, Brown ER. Estimating the efficacy of preexposure prophylaxis for HIV prevention among participants with a threshold level of drug concentration. Am J Epidemiol. 2013;177(3):256–63. https://doi.org/10.1093/aje/kws324.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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. https://doi.org/10.1056/NEJMoa1402269.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Minnis AM, Gandham S, Richardson BA, et al. Adherence and acceptability in MTN 001: a randomized cross-over trial of daily oral and topical tenofovir for HIV prevention in women. AIDS Behav. 2013;17(2):737–47. https://doi.org/10.1007/s10461-012-0333-8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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. https://doi.org/10.1056/NEJMoa1202614.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Montgomery ET, Stadler J, Naidoo S, et al. Reasons for nonadherence to the dapivirine vaginal ring: narrative explanations of objective drug-level results. AIDS. 2018;32(11):1517–25. https://doi.org/10.1097/QAD.0000000000001868.

    Article  CAS  PubMed  Google Scholar 

  11. van der Straten A, Montgomery ET, Musara P, et al. Disclosure of pharmacokinetic drug results to understand nonadherence. AIDS. 2015;29(16):2161–71. https://doi.org/10.1097/QAD.0000000000000801.

    Article  CAS  PubMed  Google Scholar 

  12. Montgomery ET, van der Straten A, Stadler J, et al. Male partner influence on women’s HIV prevention trial participation and use of pre-exposure prophylaxis: the importance of “Understanding”. AIDS Behav. 2015;19(5):784–93. https://doi.org/10.1007/s10461-014-0950-5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Milford C, Greener LR, Malherbe M, Smit J, Nel A. Partners, peers and rumours as influencers of use and attitudes towards the dapivirine vaginal ring: qualitative data from the ring study (IPM 027) in the HIV research for prevention conference. Madrid, 2018. [abstract OA05.02].

  14. Mantell JE, West BS, Sue K, et al. Health care providers: a missing link in understanding acceptability of the female condom. AIDS Educ Prev. 2011;23(1):65–77. https://doi.org/10.1521/aeap.2011.23.1.65.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Montgomery ET, Beksinska M, Mgodi N, et al. End-user preference for and choice of four vaginally delivered HIV prevention methods among young women in South Africa and Zimbabwe: the quatro clinical crossover study. J Int AIDS Soc. 2019;22(5):e25283. https://doi.org/10.1002/jia2.25283.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gill K, Pidwell T, Naidoo K, et al. UChoose: An adolescent study of HIV prevention choice in cape town, south africa in the HIV research for prevention. Madrid, 2018 [abstract OA05.06LB].

  17. Laborde ND, Leslie J, Krogstad E, et al. Perceptions of the "Fabric" - An exploratory study of a novel multi-purpose technology among women in Sub Saharan Africa. PLoS ONE. 2018;13(10):e0204821. https://doi.org/10.1371/journal.pone.0204821.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Civic D, Wilson D. Dry sex in Zimbabwe and implications for condom use. Soc Sci Med. 1996;42(1):91–8. https://doi.org/10.1016/0277-9536(95)00081-x.

    Article  CAS  PubMed  Google Scholar 

  19. 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. https://doi.org/10.1007/s10461-017-1977-1.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Duby Z, Mensch B, Hartmann M, et al. Achieving the optimal vaginal state: using vaginal products and study gels in Uganda, Zimbabwe, and South Africa. Int J Sex Health. 2017;29(3):247–57. https://doi.org/10.1080/19317611.2017.1297754.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Alcaide ML, Chisembele M, Mumbi M, Malupande E, Jones D. Examining targets for HIV prevention: intravaginal practices in Urban Lusaka. Zambia AIDS Patient Care STDS. 2014;28(3):121–7. https://doi.org/10.1089/apc.2013.0309.

    Article  PubMed  Google Scholar 

  22. 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. 2020;60(1):72–86. https://doi.org/10.1080/03630242.2019.1607803.

    Article  PubMed  Google Scholar 

  23. Braun V, Wilkinson S. Socio-cultural representations of the vagina. J Reprod Infant Psychol. 2001;19(1):17–32. https://doi.org/10.1080/02646830020032374.

    Article  Google Scholar 

  24. JC2746_en.pdf [Internet]. [cited 2019 Apr 30]. https://www.unaids.org/sites/default/files/media_asset/JC2746_en.pdf

  25. O'Sullivan LF, Harrison A, Morrell R, Monroe-Wise A, Kubeka M. Gender dynamics in the primary sexual relationships of young rural South African women and men. Cult Health Sex. 2006;8(2):99–113. https://doi.org/10.1080/13691050600665048.

    Article  PubMed  Google Scholar 

  26. Woodsong C, Alleman P. Sexual pleasure, gender power and microbicide acceptability in Zimbabwe and Malawi. AIDS Educ Prev. 2008;20(2):171–87. https://doi.org/10.1521/aeap.2008.20.2.171.

    Article  PubMed  Google Scholar 

  27. 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. https://doi.org/10.1080/13691058.2018.1552989.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank the participants of this study for their dedication and the full study team for their contribution to the implementation and analysis of this study. The Quatro study products were provided by CONRAD (led by Tim McCormick), and in partnership with Lisa Rohan at University of Pittsburgh for film supplies. The Quatro study was funded by the United States Agency for International Development (USAID) through a sub-agreement (MAPS2-15-053) under a Cooperative Agreement (AID-OAA-A-14-00010) to CONRAD, Eastern Virginia Medical School (EVMS), and by the Bill & Melinda Gates Foundation through a sub-agreement (GSB-S-15-001)and a Grant to CONRAD/EVMS (OPP1114939). The views expressed by the author(s) do not necessarily reflect the views of USAID, the United States Government, or the Bill & Melinda Gates Foundation.

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Authors and Affiliations

  1. University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe

    Petina Musara, Prisca Mutero, Nyaradzo M. Mgodi & Zvavahera M. Chirenje

  2. MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa

    Cecilia Milford & Jenni Smit

  3. Women’s Global Health Imperative, RTI International, San Francisco, CA, USA

    Mary Kate Shapley-Quinn, Rachel Weinrib, Enyonam Odoom, Ariane van der Straten & Elizabeth T. Montgomery

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

    Ariane van der Straten

  5. Eastern Virginia Medical School, CONRAD, Arlington, VA, USA

    Homaira Hanif & Meredith R. Clark

Authors
  1. Petina Musara
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  2. Cecilia Milford
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  3. Mary Kate Shapley-Quinn
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  4. Rachel Weinrib
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  7. Nyaradzo M. Mgodi
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  8. Zvavahera M. Chirenje
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  9. Homaira Hanif
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  10. Meredith R. Clark
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  11. Jenni Smit
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  12. Ariane van der Straten
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  13. Elizabeth T. Montgomery
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Quatro Study Team

Corresponding author

Correspondence to Petina Musara.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures were reviewed and approved by ethics and regulatory bodies in the US (Chesapeake IRB: 00150063), South Africa (Human Research Ethics Committee of the University of the Witwatersrand (151106); Medicines Control Council (DB: N2/19/8/2)) and Zimbabwe (Medical Research Council of Zimbabwe (MRCZ/A/1988), Medicines Control Authority of Zimbabwe (B/279/5/07/2016)) before implementation.

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Written informed consent was obtained from all the participants enrolled in the study.

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Musara, P., Milford, C., Shapley-Quinn, M.K. et al. Preferences and Acceptability of Vaginal Delivery Forms for HIV Prevention Among Women, Male Partners and Key Informants in South Africa and Zimbabwe: Qualitative Findings. AIDS Behav 25, 124–138 (2021). https://doi.org/10.1007/s10461-020-02949-4

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  • DOI: https://doi.org/10.1007/s10461-020-02949-4

Keywords

  • Vaginal microbicide delivery forms
  • Facilitators
  • Barriers
  • HIV prevention
  • sub-Saharan Africa