1
|
Stoebenau K, Muchanga G, Ahmad SSO, Bwalya C, Mwale M, Toussaint S, Maambo C, Peters CJ, Baumhart C, Mwango LK, Lavoie MCC, Claassen CW. Barriers and facilitators to uptake and persistence on prep among key populations in Southern Province, Zambia: a thematic analysis. BMC Public Health 2024; 24:1617. [PMID: 38886691 PMCID: PMC11184712 DOI: 10.1186/s12889-024-19152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Especially in high HIV prevalence contexts, such as Zambia, effective biomedical prevention tools are needed for priority populations (PPs), including key populations (KPs), who are at higher risk. HIV pre-exposure prophylaxis (PrEP) has been scaled up nationally in Zambia, but little is known about barriers to PrEP use among specific PPs to date. METHODS To understand barriers and facilitators to PrEP use in Zambia, we conducted a qualitative case study of PrEP services to PPs including sero-discordant couples (SDCs), female sex workers (FSWs), and men who have sex with men (MSM) in Livingstone. The study conducted in 2021 included in-depth interviews (n = 43) guided by the socio-ecological model, and focus group discussions (n = 4) with clinic and community-based providers and PrEP-eligible clients including users and non-users across PP groups. We used thematic analysis to analyze data using codes derived both deductively and inductively. RESULTS We found multilevel barriers and facilitators to PrEP use. Cross-cutting barriers shared across PP groups included amplifying effects of PrEP being mistaken for antiretroviral drugs used to treat HIV, including anticipated stigma, and concerns about side-effects based on both misinformation and experience. In addition, stigmatized identities, particularly that of MSM, served as a barrier to PrEP use. The fear of being mislabeled as having HIV was of greatest concern for FSWs. Facilitators to PrEP use primarily included the importance of confidential, KP-sensitive services, and the role of informed, supportive family, friends, and peers. Participants across all PP groups urged expanded education efforts to increase awareness of PrEP within the general population toward mitigating concerns of being mislabeled as living with HIV. CONCLUSION To our knowledge, this is the first qualitative study of the PrEP cascade among multiple PPs in Zambia. This study provides important explanation for the low rates of PrEP continuation found in earlier demonstration trials among KPs in Zambia. The study also offers recommendations for programming efforts going forward such as inclusive PrEP awareness campaigns, expanded KP sensitivity training, and related efforts to thwart PrEP stigma while expanding access.
Collapse
Affiliation(s)
- Kirsten Stoebenau
- University of Maryland College Park, 4200 Valley Drive, College Park, MD, 20742-2611, USA.
| | | | - Sacha St-Onge Ahmad
- University of Maryland College Park, 4200 Valley Drive, College Park, MD, 20742-2611, USA
| | - Chiti Bwalya
- University of Maryland College Park, 4200 Valley Drive, College Park, MD, 20742-2611, USA
| | - Mwangala Mwale
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Samara Toussaint
- University of Maryland College Park, 4200 Valley Drive, College Park, MD, 20742-2611, USA
| | - Choolwe Maambo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Carson J Peters
- University of Maryland College Park, 4200 Valley Drive, College Park, MD, 20742-2611, USA
| | - Caitlin Baumhart
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Marie-Claude C Lavoie
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cassidy W Claassen
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Dubé K, Mthimkhulu D, Ngcobo W, Mindry D, Maphalala L, Pillay V, Tran W, Korolkova A, Ndung’u T, Dong K. 'With this study, we have hope that something is coming': community members' perceptions of HIV cure-related research in Durban, South Africa - a qualitative focus group study. HIV Res Clin Pract 2023; 24:2243046. [PMID: 37555592 PMCID: PMC10433450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Developing a cure for HIV remains a global scientific priority. In 2022, the Females Rising through Education, Support and Health (FRESH) cohort launched an HIV cure-related trial involving an analytical treatment interruption (ATI) in Durban, South Africa. OBJECTIVES To explore community perspectives about HIV cure-related research. METHODS Between July-August 2022, we conducted three focus groups with community members. We transcribed audio recordings verbatim and used content analysis to analyze the data. RESULTS Twenty community members (13 women and 7 men) participated in three focus groups (HIV status not included). Participants viewed HIV cure-related research as a way to address the issue of defaulting on (not taking) HIV treatment. Participants expressed hesitancy around ATIs, since these contradict longstanding treatment adherence messages. Participants shared concerns around the risk of side effects from experimental interventions balanced against potential efficacy. They advocated for trial participants to have the right to decide whether to inform their sex partners about their HIV status and ATI participation, rather than research teams making disclosure mandatory. Focus group participants also emphasized the importance of using simple language to explain HIV cure-related research. CONCLUSIONS With HIV cure trials set to launch across Africa in the future, there is a critical need to better understand and respond to local community needs and preferences and to adopt this as standard practice prior to regional trial implementation.
Collapse
Affiliation(s)
- Karine Dubé
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Deli Mthimkhulu
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Wiseman Ngcobo
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Deborah Mindry
- Center for Gender and Health Justice, University of California Global Health Institute, Los Angeles, CA, USA
| | - Luyanda Maphalala
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Vanessa Pillay
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Whitney Tran
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Ana Korolkova
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, University of KwaZulu-Natal (UKZN), Durban, South Africa
- Africa Health Research Institute (AHRI), Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
| | - Krista Dong
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| |
Collapse
|
3
|
Montgomery ET, Roberts ST, Reddy K, Tolley E, Hartmann M, Wilson E, Mathebula F, Wagner LD, Zissette S, Lanham M, Wilcher R, Baeten JM, Palanee-Phillips T. Integration of a Relationship-focused Counseling Intervention with Delivery of the Dapivirine Ring for HIV Prevention to Women in Johannesburg: Results of the CHARISMA Pilot Study. AIDS Behav 2022; 26:752-763. [PMID: 34546473 PMCID: PMC8840958 DOI: 10.1007/s10461-021-03434-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/21/2022]
Abstract
Biomedical, female-initiated HIV prevention methods can help reduce disproportionately high HIV rates among women in sub-Saharan Africa, but male partner resistance and intimate partner violence (IPV) may impact ability to ensure effective use. To support consistent use of the dapivirine vaginal ring (VR), we pilot-tested the impact of the CHARISMA relationship counseling intervention ("CHARISMA") with women enrolled in the multi-site open-label Microbicide Trials Network (MTN) 025/HOPE trial at the Wits Reproductive Health and HIV Research Institute (Wits RHI) site in Johannesburg, South Africa. Lay counselors used a 42-item tool with five subscales to assess relationships and IPV and provide tailored counseling at enrolment, followed by a booster counselling session at Month 1 and follow-up checks at Months 3 and 6. We evaluated potential impact by examining self-reported ring disclosure to partners, partner clinic attendance, self-reported incident social harms (SH) and IPV, and biomarkers of ring adherence at Wits RHI. We subsequently compared these outcomes at three comparator HOPE study sites using multivariable regression models. Comparator study sites were purposively selected as those most similar to Wits RHI for baseline characteristics identified a priori. At Wits RHI, 95 of 96 (99%) HOPE participants enrolled into the CHARISMA pilot study. Mean age was 30, 36.8% lived with a partner, and 85.3% received their partner's financial support. During the six months of pilot study follow-up, participants reported: ring use disclosure to partners at 72.7% visits; 4.3% partners attending the research clinic; one partner-related SH; and 9.5% experienced incident IPV. The mean level of dapivirine released from returned used rings was 3.4 mg (SD 1.56), suggesting moderate adherence. Participants in the CHARISMA pilot had high background prevalence and incidence of IPV but were nevertheless able to adhere to ring use, and some male partners came to the research clinic. In adjusted regression models, compared to Wits RHI, partner clinic attendance was lower at all comparator sites; and significantly so at Site A (aRR 0.12, 95% CI 0.00-0.98). Sites B and C had lower levels of dapivirine released (suggesting lower adherence), but this difference was not significant. Site B women were more likely to report ring disclosure to partners at FU visits (aRR 1.12, 95% CI 1.00-1.25). IPV reported during follow-up was significantly lower at Site B (aRR 0.20, 95% CI 0.04-0.98, p = 0.047). CHARISMA taught women skills to decide on levels of ring-use disclosure to partners or others; therefore it is difficult to interpret differences in ring disclosure to partners with other sites. Similarly, CHARISMA heightened participants' awareness of abuse, possibly increasing IPV reports. Testing CHARISMA under fully-powered controlled conditions will improve understanding of its impact on women's relationships and ability to use female-initiated HIV prevention methods.
Collapse
Affiliation(s)
| | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Miriam Hartmann
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Ellen Wilson
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Florence Mathebula
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - L Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | | | | | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
4
|
Abstract
Long-acting injectable PrEP could offer an alternative to daily oral PrEP, improve adherence and protection, if found acceptable, safe and effective. HPTN 077 evaluated injectable cabotegravir safety, tolerability and pharmacokinetics among HIV-uninfected males and females in sequentially-enrolled cohorts of two dosing strategies. We compared acceptability of product attributes, prevention preferences and future interest in injectable PrEP (FIIP) by region, sex-at-birth, arm and cohort and used multivariable analysis to identify FIIP determinants. Baseline injectable PrEP preferences were higher in non-U.S. sites and increased in both regions over time. In multivariable models, FIIP was most strongly associated with acceptability of product attributes, was higher in non-U.S. sites and more altruistic participants. Treatment arm and report of pain were not associated with FIIP. Injectable acceptability was highest in non-U.S. sites. Preferences for injectable versus other PrEP methods were higher among U.S. males than females, but higher among males and females in non-U.S. settings.
Collapse
|
5
|
Roberts ST, Nair G, Baeten JM, Palanee-Philips T, Schwartz K, Reddy K, Kabwigu S, Matovu Kiweewa F, Govender V, Gaffoor Z, Singh N, Siva S, Naidoo K, Montgomery ET. Impact of Male Partner Involvement on Women's Adherence to the Dapivirine Vaginal Ring During a Phase III HIV Prevention Trial. AIDS Behav 2020; 24:1432-1442. [PMID: 31667678 DOI: 10.1007/s10461-019-02707-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although vaginal microbicides for HIV prevention are designed to be female-initiated, male partner influence has been identified as one of the most significant factors impacting women's willingness and ability to use them. As a result, research teams have sought to increase male partner involvement by encouraging disclosure of product use to male partners, promoting male partner engagement in the study through attendance at the study clinic, and helping women to garner male partner support for product use. This paper aims to assess the impact of these three elements of male partner involvement on women's adherence to the dapivirine vaginal ring during MTN-020/ASPIRE, a phase III randomized placebo-controlled clinical trial involving 2629 women in Malawi, South Africa, Uganda, and Zimbabwe. During the study, 64-80% of participants reported disclosure of ring use at each quarterly visit, and 13% reported that their partners had attended the study clinic at some point during the study. At study exit, 66% reported that their partner was supportive, 18% unsupportive, and 17% were unsure. After adjusting for age, site and time in study, women were more likely to have low ring adherence if they had an unsupportive male partner (aRR 1.29, 95% CI 1.03-1.62). Neither disclosure nor clinic attendance directly predicted ring adherence, but disclosure increased the probability of having a supportive partner (aRRR 24.17, 95% CI 16.38-35.66) or an unsupportive partner (aRRR 4.10, 95% CI 2.70-6.24), relative to an unknown level of partner support. Women were also more likely to have a supportive partner if their partner had attended the clinic (aRRR 3.77, 95% CI 1.36-10.42). This study suggests that although the vaginal ring is relatively discreet, lack of support from male partners remains a relevant barrier to use. Though both disclosure and clinic attendance may increase partner support, disclosure may also increase partner opposition. Interventions to reduce male partner opposition are needed to maximize the potential impact of the ring and other PrEP products for HIV prevention.
Collapse
Affiliation(s)
- Sarah T Roberts
- Women's Global Health Imperative, RTI International, 351 California Street, Ste. 500, San Francisco, CA, 94104, USA.
| | - Gonasagrie Nair
- Desmond Tutu HIV Research Centre, University of Cape Town, Cape Town, South Africa
| | - Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa
| | - Samuel Kabwigu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Flavia Matovu Kiweewa
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Vaneshree Govender
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Zakir Gaffoor
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Nishanta Singh
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit (HPRU), Medical Research Council (MRC), Durban, South Africa
| | - Kalendri Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Elizabeth T Montgomery
- Women's Global Health Imperative, RTI International, 351 California Street, Ste. 500, San Francisco, CA, 94104, USA
| |
Collapse
|
6
|
Relationship Type and Use of the Vaginal Ring for HIV-1 Prevention in the MTN 020/ASPIRE Trial. AIDS Behav 2020; 24:866-880. [PMID: 31111297 DOI: 10.1007/s10461-019-02521-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gender roles and imbalances in sexual power contribute to the heightened HIV-1 risk faced by women in Sub-Saharan Africa. This has led prevention research to focus on the development of female controlled methods. Despite the design of products such as vaginal rings to be used autonomously by women, male partners and women's perceptions of relationships influence HIV prevention choices. To understand the influences that male partners and dyadic dynamics had on the use of the Dapivirine Vaginal Ring in the ASPIRE trial, this analysis of qualitative data explored the types of intimate partner relationships that women engaged in. This paper describes how partners facilitated or challenged women's ring use and how women dealt with these challenges within six different types of relationships characterized by power dynamics and commitment levels. We offer insights into how future use of female-initiated HIV prevention products can be promoted through recognition of different relationship types.
Collapse
|
7
|
Hartmann M, Lanham M, Palanee-Phillips T, Mathebula F, Tolley EE, Peacock D, Pascoe L, Zissette S, Roberts ST, Wagner D, Wilson E, Ayub A, Wilcher R, Montgomery ET. Generating CHARISMA: Development of an Intervention to Help Women Build Agency and Safety in Their Relationships While Using PrEP for HIV Prevention. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:433-451. [PMID: 31550193 PMCID: PMC7082989 DOI: 10.1521/aeap.2019.31.5.433] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article describes the development of the Community Health clinic model for Agency in Relationships and Safer Microbicide Adherence intervention (CHARISMA), an intervention designed to address the ways in which gender norms and power differentials within relationships affect women's ability to safely and consistently use HIV pre-exposure prophylaxis (PrEP). CHARISMA development involved three main activities: (1) a literature review to identify appropriate evidence-based relationship dynamic scales and interventions; (2) the analysis of primary and secondary data collected from completed PrEP studies, surveys and cognitive interviews with PrEP-experienced and naïve women, and in-depth interviews with former vaginal ring trial participants and male partners; and (3) the conduct of workshops to test and refine key intervention activities prior to pilot testing. These steps are described along with the final clinic and community-based intervention, which was tested for feasibility, acceptability, and preliminary effectiveness in Johannesburg, South Africa.
Collapse
Affiliation(s)
- Miriam Hartmann
- Women's Global Health Imperative, RTI International, San Francisco, California
| | | | | | | | | | - Dean Peacock
- Sonke Gender Justice, Johannesburg, South Africa
| | - Laura Pascoe
- Sonke Gender Justice, Johannesburg, South Africa
| | | | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, San Francisco, California
| | - Danielle Wagner
- Women's Global Health Imperative, RTI International, San Francisco, California
| | - Ellen Wilson
- Women's Global Health Imperative, RTI International, San Francisco, California
| | - Asha Ayub
- Women's Global Health Imperative, RTI International, San Francisco, California
| | | | | |
Collapse
|
8
|
Clinical testing of antiretroviral drugs as future prevention against vaginal and rectal transmission of HIV infection - a review of currently available results. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2019; 69:297-319. [PMID: 31259738 DOI: 10.2478/acph-2019-0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/19/2023]
Abstract
The original purpose of vaginally applied microbicides was to slow down the HIV epidemic among the population until an effective vaccination was developed. Nowadays, antiretrovirals applied in the form of gels or vaginal rings are considered most prominent in this field and are tested via vaginal or, rarely, rectal applications in numerous clinical studies (9 different antiretroviral drugs in 33 clinical studies, especially in Africa). Only tenofovir (1 % gel) and dapivirine (25 mg in vaginal ring) progressed into the phase III clinical testing. Their efficiency depended on the user´s strict adherence to the application regimen (for tenofovir 54 %, for dapivirine 61 % in participants over 25 years of age). Despite this, they are expected to be important and effective tools of preventive medicine in the near future. This review summarizes the results obtained during long-term clinical testing (2005-2018) of antiretroviral drugs against vaginal and rectal transmission of HIV infection.
Collapse
|
9
|
Scorgie F, Stadler J, Baron D, Ju S, Ikaneng T, Mabude Z, Makgopa S, Malefo MA, Manenzhe KN, Mazibuko T, Ntjana H, Nkala B, Palanee-Phillips T, Gray G, Rees H, Delany-Moretlwe S. "It Was Not My Aim to Sleep There": The Impact of Timing and Location of Sex on Adherence to Coitally-Dependent HIV Pre-exposure Prophylaxis. AIDS Behav 2018; 22:3692-3704. [PMID: 29909589 DOI: 10.1007/s10461-018-2195-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The FACTS 001 trial found that vaginal pre- and post-coital application of 1% tenofovir gel did not prevent HIV-1 infection amongst young South African women. The trial included a multi-faceted approach to adherence support and collected objective and self-reported adherence measures. Using qualitative data collected from a random sub-set of FACTS 001 participants (135 in-depth interviews at product discontinuation and 13 focus group discussions at dissemination of trial results), we explore the importance of 'place' and 'timing' in shaping acts of sexual intimacy and product adherence. Demographically, this qualitative sub-sample is similar to the trial cohort of predominantly young, unemployed women living with parents or other family members. Sexual intimacy was largely unpredictable and happened across multiple locations in which women had limited privacy, autonomy, or control over the timing of sex. This made adherence to the dosing strategy challenging. Findings may inform the development of future event-driven pre-exposure prophylaxis regimens or products.
Collapse
Affiliation(s)
- Fiona Scorgie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa.
| | - Jonathan Stadler
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Deborah Baron
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Susan Ju
- CONRAD, 1911 North Fort Myer Drive, Arlington, VA, USA
| | - Tshepiso Ikaneng
- MEDUNSA Clinical Research Unit (MeCRU), Ga-Rankuwa, North West Province, South Africa
| | - Zonke Mabude
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | - Hilda Ntjana
- The Desmond Tutu HIV Foundation, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Thesla Palanee-Phillips
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Helen Rees
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa
| |
Collapse
|
10
|
Laborde ND, Pleasants E, Reddy K, Atujuna M, Nakyanzi T, Chitukuta M, Naidoo S, Palanee-Phillips T, Baeten JM, Montgomery ET. Impact of the Dapivirine Vaginal Ring on Sexual Experiences and Intimate Partnerships of Women in an HIV Prevention Clinical Trial: Managing Ring Detection and Hot Sex. AIDS Behav 2018; 22:437-446. [PMID: 29151197 PMCID: PMC5866044 DOI: 10.1007/s10461-017-1977-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Vaginally-inserted HIV prevention methods have been reported to impact the sexual experience for women and their partners, and hence impacts acceptability of and adherence to the method. We analyzed in-depth interviews and focus group discussions about participants' sexual experiences while wearing the ring, collected during the MTN-020/ASPIRE phase 3 safety and effectiveness trial of a dapivirine vaginal ring for HIV prevention in Malawi, South Africa, Uganda, and Zimbabwe. Most women reported that partners did not feel the ring during sex, however, women felt they had to manage their partners' interaction with or reaction to the ring. In maintaining positive relationships, women were concerned about partners' discovering ring use and about ensuring that partners had a good sexual experience with them. Finally women were concerned about how they themselves experienced sex with the ring. Some found that the ring made the vaginal environment more desirable for their partners and themselves.
Collapse
Affiliation(s)
- Nicole D Laborde
- Women's Global Health Imperative, RTI International, 351 California St. Ste. 500, San Francisco, CA, 94104, USA.
| | - Elizabeth Pleasants
- Women's Global Health Imperative, RTI International, 351 California St. Ste. 500, San Francisco, CA, 94104, USA
| | - Krishnaveni Reddy
- Wits Reproductive Health, HIV Institute (WRHI), Johannesburg, South Africa
| | | | - Teopista Nakyanzi
- Makerere University-Johns Hopkins University Research Unit, Kampala, Uganda
| | | | - Sarita Naidoo
- HIV Prevention Research Unit, South Africa Medical Research Council, Durban, South Africa
| | | | | | - Elizabeth T Montgomery
- Women's Global Health Imperative, RTI International, 351 California St. Ste. 500, San Francisco, CA, 94104, USA
| |
Collapse
|
11
|
Stalter RM, Tharaldson J, Owen DH, Okumu E, Moench T, Mack N, Tolley EE, MacQueen KM. Attitudes and perceptions towards novel objective measures of ARV-based vaginal ring use: Results from a global stakeholder survey. PLoS One 2017; 12:e0180963. [PMID: 28708847 PMCID: PMC5510854 DOI: 10.1371/journal.pone.0180963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/23/2017] [Indexed: 01/20/2023] Open
Abstract
Results of recent microbicide and pre-exposure prophylaxis clinical trials have shown adherence to be a significant challenge with new HIV prevention technologies. As the vaginal ring containing dapivirine moves into two open label follow-on studies (HOPE/MTN-025 and DREAM) and other antiretroviral-based and multi-purpose prevention technology ring products advance through the development pipeline, there is a need for more accurate and reliable measures of adherence to microbicide ring products. We previously conducted a comprehensive landscape analysis to identify new technologies that could be applied to adherence measurement of vaginal rings containing antiretrovirals. To explore attitudes and perceptions towards the approaches that we identified, we conducted a survey of stakeholders with experience and expertise in microbicide and HIV prevention clinical trials. From May to July 2015 an electronic survey was distributed via email to 894 stakeholders; a total of 206 eligible individuals responded to at least one question and were included in the data analysis. Survey respondents were presented with various objective measures and asked about their perceived acceptability to trial participants, feasibility of implementation by study staff, usefulness for measuring adherence and ethical concerns. Methods that require no additional input from the participant and require no modifications to the existing ring product (i.e., measurement of residual drug or excipient, or a vaginal analyte that enters the ring) were viewed as being more acceptable to trial participants and more feasible to implement in the field. Respondents saw value in using objective measures to provide real-time feedback on adherence. However, approaches that involve unannounced home visits for sample collection or spot checks of ring use, which could provide significant value to adherence feedback efforts, were met with skepticism. Additional research on the acceptability of these methods to potential trial participants and trial staff is recommended.
Collapse
Affiliation(s)
- Randy M. Stalter
- Contraceptive Technology Innovation Department, FHI 360, Durham, North Carolina, United States of America
- * E-mail:
| | - Jenae Tharaldson
- Global Health Research Department, FHI 360, Durham, North Carolina, United States of America
| | - Derek H. Owen
- Contraceptive Technology Innovation Department, FHI 360, Durham, North Carolina, United States of America
| | - Eunice Okumu
- Global Health Research Department, FHI 360, Durham, North Carolina, United States of America
| | - Thomas Moench
- ReProtect, Inc., Baltimore, Maryland, United States of America
| | - Natasha Mack
- Global Health Research Department, FHI 360, Durham, North Carolina, United States of America
| | - Elizabeth E. Tolley
- Global Health Research Department, FHI 360, Durham, North Carolina, United States of America
| | - Kathleen M. MacQueen
- Global Health Research Department, FHI 360, Durham, North Carolina, United States of America
| |
Collapse
|
12
|
Ntombela N, Mashamba-Thompson TP, Mtshali A, Voce A, Kharsany ABM. The dynamics of HIV transmission in out of school young heterosexual men in South Africa: a systematic scoping review protocol. Syst Rev 2017; 6:9. [PMID: 28095886 PMCID: PMC5240355 DOI: 10.1186/s13643-016-0398-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In South Africa, gender inequality dominated by males and heterosexual HIV epidemic are associated with high HIV infection. Underlying epidemiological and social determinants driving HIV acquisition and transmission are critical to understand the extent and complexity of sexual networks as primary mechanisms through which HIV is likely to spread. The aim of the study is to provide an overview of empiric evidence that links the complex interaction of risk of HIV infection in men. METHODS AND ANALYSIS We will conduct a systematic scoping review to identify, describe, and map literature on the dynamics of HIV infection in men, and we will determine the quality of the studies reporting on the dynamics of HIV infections in men. Primary research articles, published in peer-reviewed journals, review articles, and gray literature that address the research question, will be included. We will search PubMed, Web of Knowledge, Science Direct, EBSCOhost, Google Scholar, World Health Organization library, and UNAIDS database. Reference lists and existing networks such as government organizations and conferences will also be included to source relevant literature. Two independent reviewers will extract data in parallel from all relevant search engines, using specific inclusion and exclusion criteria. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo version 10. DISCUSSION We anticipate finding relevant literature on the dynamics of HIV transmission in South African men. Once summarized, data will be useful to guide future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016039489.
Collapse
Affiliation(s)
- Nonzwakazi Ntombela
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andile Mtshali
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Voce
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
13
|
Alexandre KB, Mufhandu HT, London GM, Chakauya E, Khati M. Progress and Perspectives on HIV-1 microbicide development. Virology 2016; 497:69-80. [PMID: 27429040 DOI: 10.1016/j.virol.2016.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022]
Abstract
The majority of HIV-1 infections occur via sexual intercourse. Women are the most affected by the epidemic, particularly in developing countries, due to their socio-economic dependence on men and the fact that they are often victims of gender based sexual violence. Despite significant efforts that resulted in the reduction of infection rates in some countries, there is still need for effective prevention methods against the virus. One of these methods for preventing sexual transmission in women is the use of microbicides. In this review we provide a summary of the progress made toward the discovery of affordable and effective HIV-1 microbicides and suggest future directions. We show that there is a wide range of compounds that have been proposed as potential microbicides. Although most of them have so far failed to show protection in humans, there are many promising ones currently in pre-clinical studies and in clinical trials.
Collapse
Affiliation(s)
- Kabamba B Alexandre
- Council for Scientific and Industrial Research, Pioneering Health Sciences Laboratory, Biosciences Unit, Pretoria, Gauteng, South Africa.
| | - Hazel T Mufhandu
- Council for Scientific and Industrial Research, Pioneering Health Sciences Laboratory, Biosciences Unit, Pretoria, Gauteng, South Africa
| | - Grace M London
- Department of Health Free State District Health Services and Health Programs, South Africa
| | - E Chakauya
- Council for Scientific and Industrial Research, Pioneering Health Sciences Laboratory, Biosciences Unit, Pretoria, Gauteng, South Africa
| | - M Khati
- Council for Scientific and Industrial Research, Pioneering Health Sciences Laboratory, Biosciences Unit, Pretoria, Gauteng, South Africa; University of Cape Town and Groote Schuur Hospital, Department of Medicine, Cape Town, South Africa
| |
Collapse
|