User-Identified Gel Characteristics: A Qualitative Exploration of Perceived Product Efficacy of Topical Vaginal Microbicides

Abstract

Research has demonstrated that certain vaginal gel products—microbicides containing antiretroviral drugs—may reduce HIV infection risk among women. But for vaginal gels to avert HIV and other sexually transmitted infections (STIs), at-risk women must be willing to use them as directed. These products must therefore be “acceptable” to women and an important component of acceptability is users’ perception that the product will work to prevent infection. We sought to understand how women’s perceptions of vaginal gel properties may shape their understanding of product efficacy for HIV and STI prevention. Sixteen women completed two in-depth qualitative interviews (k = 32) to identify the range and types of sensory perceptions they experienced when using two vaginal gels. We identified emergent themes and linkages between users’ sensory perceptions and their beliefs about product efficacy. Users’ predictions about product efficacy for preventing infection corresponded to measurable physical properties, including gel volume, location in the vagina, coating behavior, sensation of the gel in the vagina, leakage, and gel changes during coital acts. Although the women described similar sensory experiences (e.g., gel leaked from the vagina), they interpreted these experiences to have varying implications for product efficacy (e.g., leakage was predicted to increase or decrease efficacy). To improve microbicide acceptability, gel developers should investigate and deliberately incorporate properties that influence users’ perceptions of efficacy. When a microbicide is approved for use, providers should educate users to anticipate and understand their sensory experiences; improving users’ experience can maximize adherence and product effectiveness.

Achieving the Optimal Vaginal State: Using Vaginal Products and Study Gels in Uganda, Zimbabwe, and South Africa

“…Participants complained about the excessive volume of gel in each applicator, causing gel to leak out, wetting underwear. User challenges relating to gel consistency, leakage, and vaginal gels being ‘messy to use’ have been cited elsewhere (Morrow et al, 2014a). Optimal lubrication appears to be central to women’s preferences relating to the vaginal state; the wetness/dryness of the vagina is one characteristic frequently modified in order to enhance sexual pleasure (Hoffman et al, 2010).…”

On-demand microbicide products: design matters

“…For semisolid preparations, rheological properties, volume administered, and measures of retention and spreading are important criteria that can affect user perception such as feel (before, after and during coitus), leakage, interference with sex, and pleasure [63]. Mahan et al attempted to establish a relationship between sensory perceptions obtained in mano such as thickness, slipperiness, graininess, and rubberiness with rheology using six commercial lubricants [60].…”

Designing Preclinical Perceptibility Measures to Evaluate Topical Vaginal Gel Formulations: Relating User Sensory Perceptions and Experiences to Formulation Properties

“…Table 3 contains a listing of variable categories and scales completed by participants at each session. The Perceptibility Scales utilize a Likert scale response format developed in an earlier scale development study 13,[63][64][65][66] through intensive cognitive interviewing strategies: (1) do not agree at all, (2) agree a little, (3) agree somewhat, (4) agree a lot, (5) agree completely.…”

“…[8][9][10][11] Yet even if highly efficacious, the public health impact of anti-HIV microbicides will depend on actual use (i.e., adherence) by at-risk individuals. [12][13][14][15][16] That is, the ultimate effectiveness of any biomedical prevention technology to reduce HIV incidence will require both biological efficacy and behavioral adherence.…”