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High Acceptability of a Vaginal Ring Intended as a Microbicide Delivery Method for HIV Prevention in African Women

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Abstract

Vaginal rings (VRs) are new methods for continuous delivery of microbicides. This is the first study to quantitatively and qualitatively explore the acceptability of rings in Africa: 157 HIV-negative, sexually active women aged 18–35 used a placebo silicone elastomer ring for 12 weeks. They completed product acceptability questionnaires every 4 weeks. We conducted 6 exit focus group discussions with a subset of 48 women and 19 in-depth interviews with male partners. Retention in the study was high (97 %). Initial insertion at the clinic was successful on first attempt for 81 % of participants. Most women were comfortable using the ring, and very few (≤2 %) could feel it during daily activities or had ring-related physical or emotional problems. In the qualitative interviews many participants reported that they initially had concerns about using the ring. However, only a minority of women actually reported concerns with the ring during the study. The most frequent concern was that the ring would get lost inside the body (20 %), and this was significantly correlated with study site, frequently thinking about the ring and reporting that the ring was not very easy to remove. Qualitative data suggest that informants grew to like the ring because it felt securely placed, was unnoticeable during daily activities, and felt “normal” during sex. The ring appeared to be highly acceptable for women and men. Initial concerns with this novel method suggest a need for enhanced product counseling when VRs are introduced.

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References

  1. UNAIDS. UNAIDS reports on the global AIDS epidemic 2010. 2010; Available from: http://www.unaids.org/globalreport/default.htm.

  2. Nel A, Smythe S, Young K, Malcolm K, McCoy C, Rosenberg Z, et al. Safety and pharmacokinetics of dapivirine delivery from matrix and reservoir intravaginal rings to HIV-negative women. J Acquir Immune Defic Syndr. 2009;51(4):416–23.

    Article  PubMed  CAS  Google Scholar 

  3. Friend DR. Pharmaceutical development of microbicide drug products. Pharm Dev Technol. 2010;15(6):562–81.

    Article  PubMed  CAS  Google Scholar 

  4. Romano J, Variano B, Coplan P, Van Roey J, Douville K, Rosenberg Z, et al. Safety and availability of dapivirine (TMC120) delivered from an intravaginal ring. AIDS Res Hum Retrovir. 2009;25(5):483–8.

    Article  PubMed  CAS  Google Scholar 

  5. Tolley EE, Harrison PF, Goetghebeur E, Morrow K, Pool R, Taylor D, et al. Adherence and its measurement in phase 2/3 microbicide trials. AIDS Behav. 2010;14(5):1124–36.

    Article  PubMed  Google Scholar 

  6. Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–74.

    Google Scholar 

  7. Merkatz RB, Tokay B, Sitruk-Ware RL. Methods for female contraception: a model for innovation in drug delivery systems. Clin Pharmacol Ther. 2009;85(5):553–7.

    Article  PubMed  CAS  Google Scholar 

  8. Novak A, de la Loge C, Abetz L, van der Meulen EA. The combined contraceptive vaginal ring, NuvaRing: an international study of user acceptability. Contraception. 2003;67(3):187–94.

    Article  PubMed  CAS  Google Scholar 

  9. Shimoni N, Westhoff C. Review of the vaginal contraceptive ring (NuvaRing). J Fam Plan Reprod Health Care. 2008;34(4):247–50.

    Article  Google Scholar 

  10. Madden T, Blumenthal P. Contraceptive vaginal ring. Clin Obstet Gynecol. 2007;50(4):878–85.

    Article  PubMed  Google Scholar 

  11. Sabatinia R, Cagiano R. Comparison profiles of cycle control, side effects and sexual satisfaction of three hormonal contraceptives. Contraception. 2006;74:220–3.

    Article  Google Scholar 

  12. Nath A, Sitruk-Ware R. Progesterone vaginal ring for contraceptive use during lactation. Contraception. 2010;82(5):428–34.

    Article  PubMed  CAS  Google Scholar 

  13. Hardy E, Hebling EM, Sousa MH, Almeida AF, Amaral E. Delivery of microbicides to the vagina: difficulties reported with the use of three devices, adherence to use and preferences. Contraception. 2007;76(2):126–31.

    Article  PubMed  CAS  Google Scholar 

  14. Stewart FH, Brown BA, Raine TR, Weitz TA, Harper CC. Adolescent and young women’s experience with the vaginal ring and oral contraceptive pills. J Pediatr Adolesc Gynecol. 2007;20(6):345–51.

    Article  PubMed  Google Scholar 

  15. Smith DJ, Wakasiaka S, Hoang TD, Bwayo JJ, Del Rio C, Priddy FH. An evaluation of intravaginal rings as a potential HIV prevention device in urban Kenya: behaviors and attitudes that might influence uptake within a high-risk population. J Womens Health (Larchmt). 2008;17(6):1025–34.

    Google Scholar 

  16. Woodsong C, Montgomery E, Masenga G, Mollendorf C, Bekker L, Ganesh S, et al., editors. Safety and acceptability of vaginal ring as microbicide delivery method in African women. International partnership for microbicides. Silver Spring, MD; 2010.

  17. Nel A, Young K, Romano J, Woodsong C, van der Straten A, Masenga G, et al. Safety and acceptability of silicone elastomer vaginal rings as potential microbicide delivery method in African women. International partnership for microbicides. Silver Spring, MD; 2011.

  18. Simons-Rudolph A, Woodsong C, Koo H. Modeling the social context of microbicide use. Microbicide Q. 2008;6(4):1–11.

    Google Scholar 

  19. Woodsong C, Alleman P. Sexual pleasure, gender power and microbicide acceptability in Zimbabwe and Malawi. AIDS Educ Prev. 2008;20(2):171–87.

    Article  PubMed  Google Scholar 

  20. Sahin-Hodoglugil N, Montgomery ET, Kacanek D, Morar NS, Mtetwa S, Nkala B, et al. User experiences and acceptability attributes of the diaphragm and lubricant gel in an HIV prevention trial in Southern Africa: a theory based qualitative analysis (under review). 2010.

  21. Woodsong C, Simons-Rudolph A, Alleman P. A comprehensive and flexible conceptual framework for investigating acceptability in microbicide clinical trials (poster presentation). Microbicides 2008. Delhi, India; 2008.

  22. Montgomery ET, van der Straten A, Cheng H, Wenger L, Mesanga G, Rees H, et al. Vaginal ring adherence in sub-saharan Africa: expulsion, removal, and perfect use. International AIDS conference 2011, July 17–20, Rome, Italy 2011.

  23. Bhaduri M, Carr LK, Dunn S, Glanc P. The vaginal ring: expelled or misplaced? J Ultrasound Med. 2009;28(2):259–61.

    Google Scholar 

  24. Kang MS, Buck J, Padian N, Posner SF, Khumalo-Sakutukwa G, van der Straten A. The importance of discreet use of the diaphragm to Zimbabwean women and their partners. AIDS Behav. 2007;11(3):443–51.

    Article  PubMed  Google Scholar 

  25. Averbach S, Sahin-Hodoglugil N, Musara P, Chipato T, van der Straten A. Duet® for menstrual protection: a feasibility study in Zimbabwe. Contraception. 2009.

  26. Mantell J. Women in the time of AIDS: barriers, bargains, and benefits. AIDS Educ Prev. 2008;20(2):91–106.

    Article  PubMed  Google Scholar 

  27. Green G, Pool R, Harrison S, Hart GJ, Wilkinson J, Nyanzi S, et al. Female control of sexuality: illusion or reality? Use of vaginal products in south west Uganda. Soc Sci Med. 2001;52(4):585–98.

    Article  PubMed  CAS  Google Scholar 

  28. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Nov 23.

  29. Nel A, Kamupira M, Woodsong C, Montgomery E, Nuttall J, editors. Safety, acceptability, and adherence of monthly dapiravine vaginal microbicide rings for HIV prevention. 19th conference on retroviruses and opportunistic infections (CROI 2012), 2012 March 5–8, 2012, Seattle, WA.

  30. Woodsong C, Shedlin M, Koo H. The ‘natural’ body, God and contraceptive use in the southeastern United States. Culture Health Sex. 2004;6(1):61–78.

    Article  Google Scholar 

  31. Stadler J, Saethre E. Blockage and flow: intimate experiences of condoms and microbicides in a South African clinical trial. Culture Health Sex. 2011;13(1):31–44.

    Article  Google Scholar 

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Acknowledgments

We would like to acknowledge the women who participated in this study, the IPM 011 study team, and to extend special thanks to the research sites’ clinical and social science teams in Moshi, Johannesburg, Durban, and Cape Town. This work was supported by the International Partnership for Microbicides (IPM).

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Authors and Affiliations

  1. Women’s Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA, 94104, USA

    A. van der Straten, E. T. Montgomery, H. Cheng & L. Wegner

  2. Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    A. van der Straten

  3. Kiliminjaro Christian Medical Center, Moshi, Tanzania

    G. Masenga

  4. Wits Reproductive Health and HIV Research Institute, Johannesburg, South Africa

    C. von Mollendorf

  5. University of Cape Town and Desmond Tutu HIV Foundation, Cape Town, South Africa

    L. Bekker

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

    S. Ganesh

  7. International Partnership for Microbicides, Paarl, South Africa

    K. Young, A. Nel & C. Woodsong

  8. NWJ Group, LLC, Wayne, PA, USA

    J. Romano

Authors
  1. A. van der Straten
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  2. E. T. Montgomery
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  3. H. Cheng
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  4. L. Wegner
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  5. G. Masenga
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  6. C. von Mollendorf
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  7. L. Bekker
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  8. S. Ganesh
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  9. K. Young
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  10. J. Romano
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  11. A. Nel
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  12. C. Woodsong
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Corresponding author

Correspondence to A. van der Straten.

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RTI International is a trade name of Research Triangle Institute.

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van der Straten, A., Montgomery, E.T., Cheng, H. et al. High Acceptability of a Vaginal Ring Intended as a Microbicide Delivery Method for HIV Prevention in African Women. AIDS Behav 16, 1775–1786 (2012). https://doi.org/10.1007/s10461-012-0215-0

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  • DOI: https://doi.org/10.1007/s10461-012-0215-0

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