Abstract
BackgroundClinical trials have found that a monthly dapivirine vaginal ring was well-tolerated and reduced HIV-1 risk among women in sub-Saharan Africa. However, in order for the ring or other novel prevention methods to have optimal impact, it is necessary to understand and address women’s challenges to uptake and adherence. This paper provides insight into a few key challenges noted by women using the ring and contraceptives simultaneously.MethodsThe qualitative portion of the MTN-020/ASPIRE study consisted of data collection using single in-depth interviews, serial in-depth interviews, and focus group discussions, conducted with 214 participants across 15 sites in Malawi, South Africa, Uganda and Zimbabwe. A coding team used qualitative analysis software to identify themes within the interviews.ResultsThe primary qualitative themes among participant data pertained to side effects. Participants reported negative side effects related to menses, in some cases attributing these effects to their contraceptives and in others to the vaginal ring. Participants also expressed concern over the long-term impact of contraception and ring use on fertility, including the reversibility of the contraceptive, especially among nulliparous women.ConclusionsWomen’s attitudes toward contraceptives can impact their willingness to concurrently use and adhere to a novel HIV prevention product. To optimize the potential of both prevention products, researchers should pre-emptively address concerns about contraceptive impact on fertility and counsel women about the expected side effects of contraceptives versus the ring.Clinical trials identifier NCT01617096. Registered on 6-12-2012 at clinicaltrials.gov https://clinicaltrials.gov/ct2/show/NCT01617096
Highlights
Clinical trials have found that a monthly dapivirine vaginal ring was well-tolerated and reduced HIV-1 risk among women in sub-Saharan Africa
Women of childbearing age in sub-Saharan Africa continue to face disproportionate risk of HIV-1 acquisition compared to men and their global counterparts [1]
The qualitative portion consisted of single in-depth interviews (IDI), serial IDIs (SIDI), and focus group discussions (FGD), conducted with a total of 214 participants composed of those who were randomly preselected from ASPIRE participants, those who were purposively selected as “special cases” based on their unique adherence experiences, and those who discontinued early because of HIV seroconversion [6]
Summary
Clinical trials have found that a monthly dapivirine vaginal ring was well-tolerated and reduced HIV-1 risk among women in sub-Saharan Africa. In order for the ring or other novel prevention methods to have optimal impact, it is necessary to understand and address women’s challenges to uptake and adherence. In the MTN 020/ASPIRE trial, women were required to use a highly effective method of contraception throughout their participation, as the effect of the drug and ring on the fetus or pregnancy was unestablished [2]. In order for the ring or other novel prevention methods to have optimal impact on reducing risk of HIV infection, it is necessary to address factors that influence women’s fears and concerns [5], as well as other challenges to uptake and adherence. Widespread adoption of the dapivirine ring requires that issues around users’ fear of contraceptive side effects be recognized in the context of adherence to the ring
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