Impact of Contraceptives on Cervico-Vaginal Mucosa (UMPALA)

The UMPALA Study: A Clinical Study to Assess the Impact of Contraceptives on the Cervico-Vaginal Mucosa

UMPALA is a research study to look at the effect of four different, approved contraceptives on the cervical and vaginal tissues as well as on factors in the blood. Participants will have a baseline examination then receive one of four approved, marketed contraceptive products. Cervico-vaginal assessments will take place 4 weeks after contraceptive initiation and 3 months after to assess changes in mucosal safety after use of various contraceptive products in young, healthy, HIV uninfected women.

Study Overview

• Status: Completed
• Conditions: Contraceptive; Complications, Intrauterine; Mucosal Inflammation
• Intervention / Treatment: Drug: Copper IUD; Drug: Etonogestrel implant; Drug: Levonorgestrel IUS; Drug: DMPA Sub-cutaneous

Detailed Description

This clinical study will complete approximately 12 healthy, non-pregnant, HIV-uninfected women aged 18-50 years per contraceptive arm, who are at low risk for sexually transmitted infections (STIs) at two clinical sites, for a total of approximately 96 completed participants. The study will examine changes from baseline, pre-contraceptive dosing to post contraceptive dosing of cervico-vaginal mucosal safety and adverse events.

Participants at each site will be randomized (1:1:1:1) to one of four, marketed, approved contraceptive dosing forms: Levonorgestrel (LNG) 52 mg. Intrauterine System (IUS), Copper Intrauterine Device (IUD), etonogestrel (ETG, Nexplanon, Implanon) contraceptive implant, or DMPA SC contraceptive injection.

Enrollment is expected to take approximately 8 months and each participant is expected to complete the study within 4 months.

• Study Type: Interventional
• Enrollment (Actual): 112
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Andrea Thurman, MD; Phone Number: 757.446.8931; Email: thurmaar@evms.edu
• Study Contact Backup: Name: Karen Dominguez, MPH; Email: domingk@evms.edu

Study Locations

• Kenya
  • Central
    • Thika, Central, Kenya, 01000
      • KEMRI
• United States
  • Virginia
    • Norfolk, Virginia, United States, 23507
      • Eastern Virginia Medical School

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 18 to 50 years, inclusive
• In general good health without any significant systemic disease and with an intact uterus and cervix.
• History of Pap smears and follow-up consistent with standard, local clinical practice or willing to undergo a Pap smear at Visit 1
• Willing to give voluntary consent and sign an informed consent form
• Willing and able to comply with protocol requirements, including accepting randomization to study contraceptive products
• If currently on a contraceptive product, willing to go off products and use condoms for birth control for a specified time
• If in a relationship, must be with a partner who is not known to be HIV positive and has no know risk of sexually transmitted infections (STIs)

Exclusion Criteria:

• Positive pregnancy test or plans to become pregnant during the course of the study
• Currently exclusively breastfeeding or planning to exclusively breastfeed during the course of the study
• Less than six weeks from a delivery of an infant greater than 20 weeks gestation
• Use of DMPA in the past 4 months
• Clinical signs and symptoms of menopause
• Current WHO or CDC medical eligibility criteria level 3 or 4 for any contraceptive product to which a participant could receive at the clinical site
• History of sensitivity/allergy to any component of the study product, topical anesthetic, or to both silver nitrate and Monsel's solution
• Current infection with Trichomonas vaginalis (TV), Neisseria gonorrhea (NG), Chlamydia trachomatis (CT)
• Current positive test for HIV
• History of a pulmonary embolus or deep vein thrombosis
• Chronic or acute vulvar or vaginal symptoms (pain, irritation, spotting/bleeding, discharge, etc)
• Known blood disorder, eg. von Willebrands disease, that could lead to prolonged or continuous bleeding with biopsy
• Chronic use systemic corticosteroids, antibiotics, antimycobacterials, anticoagulants or other drugs known to prolong bleeding and/or promote clotting, antifungals, or antivirals or antiretrovirals.
• Current or anticipated chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for the duration of the study
• Participation in any other investigational trial with use of a drug/device within the last 30 days or planned participation in any other investigational trial with use of a drug/device during the study
• Abnormal finding on laboratory or physical examination or a social or medical condition in which, in the opinion of the investigator, would make participation in the study unsafe or would complicate interpretation of the data

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Copper IUD; The copper IUD contains approximately 176 mg of copper wire wrapped around a vertical stem. It is FDA approved for pregnancy prevention for 10 years.	Drug: Copper IUD; Participants randomized to Copper IUD will receive Paragard IUD at Visit 2.; Other Names: Paragard
Active Comparator: Etonogestrel Implant; The ETG implant is a single, radiopaque, rod shaped implant containing 68 mg of etonogestrel. It is FDA approved for pregnancy prevention for 3 years.	Drug: Etonogestrel implant; Participants randomized to ETG implant will receive the implant at Visit 2.; Other Names: Nexplanon; Implanon
Active Comparator: Levonorgestrel IUS; The LNG IUS contains approximately 52 mg. of LNG. It is FDA approved for pregnancy prevention for 5 - 6 years.	Drug: Levonorgestrel IUS; Participants randomized to LNG intrauterine system will receive the IUS at Visit 2.; Other Names: Mirena; Liletta
Active Comparator: DMPA Sub-cutaneous; DMPA contains 104 mg of medroxyprogesterone acetate in 0.65 mL of fluid, administered by subcutaneous injection in the abdominal fat, thigh or skin over the deltoid muscle. It is FDA approved for pregnancy prevention for 14 weeks.	Drug: DMPA Sub-cutaneous; Participants randomized to DMPA SC will receive the injection at Visit 2.; Other Names: Subcutaneous depot medroxyprogesterone acetate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants with changes to mucosal function	Evaluate mucosal factors and microbiome changes from baseline associated with mucosal function and reproductive health, including vaginal glycogen, pH, lactic acid, soluble markers and immune cells.	4 weeks and 3 months after product use
Number of participants with changes to mucosal health	Evaluate mucosal factors and microbiome changes from baseline associated with mucosal function and reproductive health, including vaginal glycogen, pH, lactic acid, soluble markers and immune cells.	4 weeks and 3 months after product use

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants with systemic inflammation	Evaluate changes from baseline in systemic factors associated with reproductive health, including C reactive protein and hormone concentrations.	4 weeks and 3 months after product use

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mucosal susceptibility to pathogens	Model mucosal susceptibility to STIs ex vivo at baseline and after contraceptive use	4 weeks and 3 months after product use

Collaborators and Investigators

• Sponsor: Eastern Virginia Medical School
• Collaborators: United States Agency for International Development (USAID); CONRAD; Kenya Medical Research Institute
• Investigators: Principal Investigator: Andrea Thurman, Eastern Virginia Medical School, CONRAD

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2021
• Primary Completion (Actual): December 15, 2022
• Study Completion (Actual): December 15, 2022

Study Registration Dates

• First Submitted: March 18, 2021
• First Submitted That Met QC Criteria: March 22, 2021
• First Posted (Actual): March 24, 2021

Study Record Updates

• Last Update Posted (Actual): August 25, 2023
• Last Update Submitted That Met QC Criteria: August 24, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: Contraception; Reproductive health; Copper IUD; Etonogestrel implant; DMPA sub-cutaneous; Levonorgestrel IUS
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Gastrointestinal Diseases; Gastroenteritis; Stomatognathic Diseases; Mouth Diseases; Inflammation; Mucositis; Physiological Effects of Drugs; Antineoplastic Agents; Antineoplastic Agents, Hormonal; Trace Elements; Micronutrients; Contraceptive Agents, Hormonal; Contraceptive Agents; Reproductive Control Agents; Contraceptives, Oral; Contraceptive Agents, Female; Contraceptives, Oral, Synthetic; Contraceptives, Oral, Hormonal; Contraceptive Agents, Male; Copper; Levonorgestrel; Medroxyprogesterone Acetate; Medroxyprogesterone; Etonogestrel
• Other Study ID Numbers: CONRAD D20-149

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes