Experiences with simultaneous use of contraception and the vaginal ring for HIV prevention in sub-Saharan Africa

Jonah Leslie, Flavia Kiweewa, Thesla Palanee-Phillips, Katherine Bunge, Felix Mhlanga, Betty Kamira, Jared Baeten, Ariana Katz, Sharon Hillier, Elizabeth Montgomery, MTN-020/ASPIRE Study Team, Jared Baeten, Thesla Palanee-Phillips, Elizabeth Brown, Lydia Soto-Torres, Katie Schwartz, Bonus Makanani, Francis Martinson, Linda-Gail Bekker, Vaneshree Govender, Samantha Siva, Zakir Gaffoor, Logashvari Naidoo, Arendevi Pather, Nitesha Jeenarain, Gonasagrie Nair, Thesla Palanee-Phillips, Flavia Matovu, Nyaradzo Mgodi, Felix Mhlanga, Jonah Leslie, Flavia Kiweewa, Thesla Palanee-Phillips, Katherine Bunge, Felix Mhlanga, Betty Kamira, Jared Baeten, Ariana Katz, Sharon Hillier, Elizabeth Montgomery, MTN-020/ASPIRE Study Team, Jared Baeten, Thesla Palanee-Phillips, Elizabeth Brown, Lydia Soto-Torres, Katie Schwartz, Bonus Makanani, Francis Martinson, Linda-Gail Bekker, Vaneshree Govender, Samantha Siva, Zakir Gaffoor, Logashvari Naidoo, Arendevi Pather, Nitesha Jeenarain, Gonasagrie Nair, Thesla Palanee-Phillips, Flavia Matovu, Nyaradzo Mgodi, Felix Mhlanga

Abstract

Background: Clinical 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.

Methods: The 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.

Results: The 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.

Conclusions: Women'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://ichgcp.net/clinical-trials-registry/NCT01617096.

Keywords: Africa South of the Sahara; Clinical trial; Contraception; HIV; Qualitative research; Vaginal ring.

Conflict of interest statement

The authors declare that they have no competing interests.

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Source: PubMed

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