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

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.

Intravaginal ring eluting tenofovir disoproxil fumarate completely protects macaques from multiple vaginal simian-HIV challenges

“…Thus, it is reasonable to assume that it will be easier for women to adhere to long-duration IVR delivery systems compared with daily, episodic, or coitally dependent gels. This is supported by the fact that IVRs have seen excellent product demand and commercial success as a form of birth control in high-income countries and are gaining acceptance in low-income countries (7,29).…”

Engaging male partners in women's microbicide use: evidence from clinical trials and implications for future research and microbicide introduction

“…Subsequent research has found that although many women appreciate a product they can use without a partner's knowledge [2–7], microbicide trial participants typically talked with their steady partners about the product [3, 6, 8–12]. Moreover, male partners’ awareness and acceptance of product use influenced trial participants’ product acceptance and self-reported adherence [7, 13–16].…”

Combination HIV Prevention Interventions: The Potential of Integrated Behavioral and Biomedical Approaches

“…During pre-clinical or clinical trials, acceptability of the candidate microbicides of nonoxynol-9 [15, 16], cellulose sulfate [17], BufferGel [9, 18, 19], PRO 2000 Gel [18–20], a vaginal ring microbicide delivery modality [21], and tenofovir [22–24] were examined. In what follows, we briefly review acceptability data for each of the candidate microbicides.…”

“…An additional study examined the acceptability of a vaginal ring to continuously deliver microbicides via a mixed-methods design among HIV-negative, sexually active women and their male partners [21]. The majority of women (69%) reported high levels of interest in trying the vaginal ring and liked the possibility that the ring could prevent HIV and not interfere with sexual activity [21].…”