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Mayanja Y, Kayesu I, Kamacooko O, Lunkuse JF, Muturi-Kioi V, Price M, Kosidou K, Ekström AM. Preference for novel biomedical HIV pre-exposure prophylaxis methods among adolescent girls and young women in Kampala, Uganda: a mixed methods study. Front Public Health 2024; 12:1369256. [PMID: 38846614 PMCID: PMC11153736 DOI: 10.3389/fpubh.2024.1369256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024] Open
Abstract
Background Novel HIV pre-exposure prophylaxis (PrEP) methods including a potential future HIV vaccine, will increase prevention options for adolescent girls and young women (AGYW) at high risk of HIV infection in Eastern and Southern Africa, yet data on AGYW's preferences for various PrEP methods is limited. We investigated preferences for five biomedical PrEP methods (oral, injectable, vaginal ring, implant, HIV vaccine) among 14-24-years-old AGYW in Kampala, Uganda. Methods From January to December 2019, we conducted a mixed methods study including 265 high-risk AGYW. After receiving two education sessions on the five PrEP methods, participants were asked about their "most preferred PrEP method." Multinomial logistic regression (oral PrEP as reference category) was used to determine participant characteristics associated with method preference. Results are presented as adjusted relative risk ratios (aRRR) with 95% confidence intervals (CI). In-depth interviews were conducted with 20 selected participants to examine reasons influencing PrEP preferences and suggestions for method improvements. Transcripts were analyzed thematically. Results Participants preferred methods were: HIV vaccine (34.7%), oral PrEP (25.7%), injectable PrEP (24.9%), PrEP implant (13.6%), and vaginal ring (1.1%). Preference for injectable PrEP increased with every year of age (aRRR 1.22; 95% CI 1.04-1.44) and among participants with chlamydia or gonorrhoea (aRRR 2.53; 95% CI 1.08-5.90), while it was lower among participants having sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.30; 95% CI 0.10-0.91). Preference for PrEP implants also increased with age (aRRR 1.42; 95% CI 1.14-1.77) and was strong among participants having ≥10 sexual partners in the past 3 months (aRRR 3.14; 95% CI 1.16-8.55), while it was lower among those with sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.25; 95% CI 0.07-0.92). PrEP method preference was influenced by product attributes and prior experiences with similar product forms commonly used in health care. Conclusion AGYW have varied preferences for biomedical PrEP method and those with higher sexual behavioral risk prefer long-acting methods. As we anticipate more available PrEP options, oral PrEP use should be supported among AGYW, especially for those with sexual partners living with HIV or of unknown HIV status.
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Affiliation(s)
- Yunia Mayanja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ivy Kayesu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Onesmus Kamacooko
- Child Health and Development Centre, School of Medicine, Makerere University, Kampala, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | | | - Matt Price
- 4IAVI, New York, NY, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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Yeh PT, Kautsar H, Kennedy CE, Gaffield ME. Values and preferences for contraception: A global systematic review. Contraception 2022; 111:3-21. [PMID: 35525287 PMCID: PMC9232836 DOI: 10.1016/j.contraception.2022.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To identify and synthesize original research on contraceptive user values, preferences, views, and concerns about specific family planning methods, as well as perspectives from health workers. STUDY DESIGN We conducted a systematic review of global contraceptive user values and preferences. We searched 10 electronic databases for qualitative and quantitative studies published from 2005 to 2020 and extracted data in duplicate using standard forms. RESULTS Overall, 423 original research articles from 93 countries among various groups of end-users and health workers in all 6 World Health Organization regions and all 4 World Bank income classification categories met inclusion criteria. Of these, 250 (59%) articles were from high-income countries, mostly from the United States of America (n = 139), the United Kingdom (n = 29), and Australia (n = 23). Quantitative methods were used in 269 articles, most often cross-sectional surveys (n = 190). Qualitative interviews were used in 116 articles and focus group discussions in 69 articles. The most commonly reported themes included side effects, effectiveness, and ease/frequency/duration of use. Interference in sex and partner relations, menstrual effects, reversibility, counseling/interactions with health workers, cost/availability, autonomy, and discreet use were also important. Users generally reported satisfaction with (and more accurate knowledge about) the methods they were using. CONCLUSIONS Contraceptive users have diverse values and preferences, although there is consistency in core themes across settings. Despite the large body of literature identified and relevance to person-centered care, varied reporting of findings limited robust synthesis and quantification of the review results.
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Hunied Kautsar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary E Gaffield
- Contraception and Fertility Care Team, Department of Sexual and Reproductive Health and Research, World Health Organization, Genève, Switzerland.
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Palmeira-de-Oliveira R, Oliveira AS, Rolo J, Tomás M, Palmeira-de-Oliveira A, Simões S, Martinez-de-Oliveira J. Women's preferences and acceptance for different drug delivery routes and products. Adv Drug Deliv Rev 2022; 182:114133. [PMID: 35104506 DOI: 10.1016/j.addr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy, but are related to a complex network of perceptions, preferences, personal and cultural backgrounds, and results from previous experiences. Women's preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches). Much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women's preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women's preferences and acceptance for different dosage forms and drug delivery routes involved in women's health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
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Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.
| | - Ana Sofia Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| | - Mariana Tomás
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Sérgio Simões
- CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
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Ridgeway K, Montgomery ET, Smith K, Torjesen K, van der Straten A, Achilles SL, Griffin JB. Vaginal ring acceptability: A systematic review and meta-analysis of vaginal ring experiences from around the world. Contraception 2022; 106:16-33. [PMID: 34644609 PMCID: PMC9128798 DOI: 10.1016/j.contraception.2021.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The vaginal ring (ring) is a female-initiated, long-acting drug delivery system for different indications, including HIV prevention. Our aim was to provide evidence for acceptability of the vaginal ring across indications to support dapivirine and multipurpose prevention technology ring introduction and roll out. STUDY DESIGN This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Web of Science, Embase, and grey literature for publications reporting favorable ring acceptability and secondary outcomes involving actual ring use (comfort, ease of ring use, ring comfort during sex, expulsions, and vaginal symptoms) or hypothetical acceptability for any indication published January 1, 1970-June 15, 2021. We estimated random-effects pooled prevalence, assessing between-study variation using meta-regression. RESULTS Of 2,234 records, we included 123 studies with 40,434 actual and hypothetical ring users. The primary outcome assessment included 50 studies with 60 ring subgroups totaling 19,271 ring users. The favorable acceptability pooled prevalence was 85.6% (95%CI 81.3, 89.0), while hypothetical acceptability among non-ring users was 27.6% (95%CI 17.5, 40.5). In meta-regression, acceptability was higher in menopause (95.4%; 95%CI 88.4, 98.2) compared to contraceptive rings (83.7%; 95%CI 75.6, 89.5). Acceptability was lower in pharmacokinetic studies (50%; 95%CI 22.1, 77.9) compared to RCTs (89.5%; 95%CI 85.8.92.4) and in studies assessing acceptability at ≥12 months (78.5%; 95%CI 66.5, 87.1) versus studies assessing acceptability at <3 months (91.9%; 95%CI 83.7, 96.1). European (90.6%; 95%CI 83.9, 94.7), Asian (97.1%; 95%CI 92.0, 99.0), and multi-region studies (93.5%; 95%CI 84.6, 97.4) reported more favorable acceptability compared to African studies (59.4%; 95%CI 38.3, 77.5). Secondary outcomes were similarly favorable, including ring comfort (92.9%; 95%CI 89.2, 95.4), ease of use (90.9%; 95%CI 86.5, 94.0), and comfort during sex (82.7%; 95%CI 76.4, 87.6). Limitations include inconsistent outcome definitions and unmeasured factors affecting acceptability. CONCLUSIONS Women who used vaginal rings reported they were acceptable across indications geographic regions and indications. Policy makers should consider the ring as an important option for pregnancy and HIV prevention drug development. IMPLICATIONS This review found favorable acceptability among vaginal ring users across indications and geographic areas, in contrast to low hypothetical acceptability among non-users. Vaginal rings are an important drug delivery system for pregnancy and HIV preventions, and scale-up should plan to address initial hesitancy among new users.
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Affiliation(s)
- Kathleen Ridgeway
- FHI 360, Global Health Population Nutrition, Durham, NC, United States
| | - Elizabeth T. Montgomery
- RTI International, Women’s Global Health Imperative, Berkeley, CA, United States,Center for AIDS Pervention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Kevin Smith
- Centre for Global Health, RTI International, Durham, NC, United States
| | - Kristine Torjesen
- FHI 360, Global Health Population Nutrition, Durham, NC, United States
| | - Ariane van der Straten
- RTI International, Women’s Global Health Imperative, Berkeley, CA, United States,Center for AIDS Pervention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sharon L. Achilles
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Jennifer B. Griffin
- Centre for Global Health, RTI International, Durham, NC, United States,Corresponding author. J. B. Griffin, (J.B. Griffin)
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Using Emoji Stickers to Understand End-User Opinions of the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav 2021; 25:3955-3966. [PMID: 34180041 DOI: 10.1007/s10461-021-03338-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Globally, HIV affects women disproportionally to men, particularly in sub-Saharan Africa. While the monthly dapivirine vaginal ring (VR) is a promising female-initiated HIV prevention method, it is important to understand how well the ring is liked. With former participants of HOPE, an open-label extension trial of the ring, we used emoji stickers and a worksheet to explore female end-user's acceptability of and opinions about the VR. We aimed to understand these participants' opinions about the VR, and how they had changed over time, particularly in the context of known efficacy of the dapivirine VR. Most participants easily understood the exercise and how to use the emoji stickers, with a few exceptions. For those who had trouble understanding how to use the emoji, interviewer support and encouragement helped them to understand and continue with the exercise. Emoji interpretation varied widely with participants using the same emoji to express divergent opinions. Using the emoji stickers, participants expressed mostly positive opinions of the vaginal ring for HIV prevention, with some lingering concerns about the product's partial effectiveness. This paper contributes to the literature supporting the assertion that the dapivirine VR for HIV prevention is acceptable to women, and that acceptability increases with time and proper education. This analysis also provides evidence that emoji visual tools can enhance understanding of acceptability of an intervention when used in qualitative research.
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Raidoo S, Pearlman Shapiro M, Kaneshiro B. Contraception in Adolescents. Semin Reprod Med 2021; 40:89-97. [PMID: 34500476 DOI: 10.1055/s-0041-1735629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescents are at risk for unwanted pregnancy when they become sexually active, and contraception is an important part of mitigating this risk. Use of contraceptive methods, and long-acting reversible contraceptive methods such as implants and intrauterine devices in particular, has increased among adolescents. Although sexual activity has declined and contraceptive use has increased among adolescents in the United States in recent years, the unintended pregnancy rate remains high. All of the currently available contraceptive methods are safe and effective for adolescents to use; however, adolescents may have specific concerns about side effect profiles and unscheduled bleeding that should be addressed during contraceptive counseling. Healthcare providers should prioritize adolescents' needs and preferences when approaching contraceptive counseling, and also consider the unique access and confidentiality issues that adolescents face when accessing contraception.
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Affiliation(s)
- Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Marit Pearlman Shapiro
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
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Ti A, Soin K, Rahman T, Dam A, Yeh PT. Contraceptive values and preferences of adolescents and young adults: A systematic review. Contraception 2021; 111:22-31. [PMID: 34077748 DOI: 10.1016/j.contraception.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to systematically review the literature on values and preferences for contraception among adolescents and young adults globally. STUDY DESIGN We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding end-users' values and preferences for contraception. We included studies that report specifically on people up to 25 years old. RESULTS Fifty-five studies out of 7,846 met our inclusion criteria. These studies included participants aged 10-25 years and were conducted in 16 countries. Through open coding, we identified 18 content areas. The five most commonly discussed content areas were: (1) general preferences regarding contraception, (2) contraceptive method benefits, (3) contraceptive method drawbacks, (4) the influence of the social context, and (5) the influence of myths and misconceptions, including safety and side effects, on contraceptive choice. Privacy and autonomy were important overarching themes, along with safety of the method. These considerations affected participants' access to and use of contraception. CONCLUSION Various social, cultural, and method-specific factors influence a young person's values and preferences around contraceptive methods. Understanding their values and preferences can help providers and programs improve contraceptive care for young people.
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Affiliation(s)
- Angeline Ti
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA United States.
| | - Komal Soin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Family Medicine and Community Health, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States
| | - Tasfia Rahman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Anita Dam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ping T Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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A Mixed-Methods Study Examining Adherence to and Acceptability of Intravaginal Rings for HIV Prevention: Behavioral Results of MTN-027. AIDS Behav 2020; 24:607-616. [PMID: 30877580 DOI: 10.1007/s10461-019-02457-0] [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: 01/15/2023]
Abstract
Intravaginal rings (IVR) containing antiretroviral drugs are a promising method for HIV prevention. We triangulated quantitative and qualitative assessments to evaluate the acceptability of four IVRs used continuously for 28 days as part of a Phase I trial (N = 48 HIV-negative women; ages 18-45). Adherence was high throughout the trial, yet 30% of participants reported involuntary IVR expulsions followed by re-insertion. Most participants (93.6%) felt comfortable with the IVR being inside their body. Participants reported liking the IVR more (36.2%) or the same amount (55.3%) since starting the study. When given the option of choosing between the IVR and/or a male condom for HIV-prevention, most reported preferring the IVR (n = 29, 63.0%), and over a quarter of the sample reported liking them equally (n = 12, 26.1%). We observed no differences in IVR acceptability across the study arms. High adherence and acceptability underscores the promise of an IVR as a female-controlled, sustained mechanism for HIV prevention.
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Vargas SE, Midoun MM, Guillen M, Getz ML, Underhill K, Kuo C, Guthrie KM. A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 45:25-34. [PMID: 31592770 DOI: 10.1363/45e7619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CONTEXT Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.
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Affiliation(s)
- Sara E Vargas
- Research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI,
| | - Miriam M Midoun
- Graduate student, Department of Comparative Human Development, University of Chicago
| | - Melissa Guillen
- Project director, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | | | - Kristen Underhill
- Associate professor, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York
| | - Caroline Kuo
- Associate professor (research), Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Kate M Guthrie
- Senior research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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Vargas SE, Midoun MM, Guillen M, Getz ML, Underhill K, Kuo C, Guthrie KM. A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:71-80. [PMID: 31108027 PMCID: PMC6662569 DOI: 10.1363/psrh.12103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/28/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.
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Affiliation(s)
- Sara E. Vargas
- Research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Miriam M. Midoun
- Graduate student, Department of Comparative Human Development, University of Chicago
| | - Melissa Guillen
- Project director, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | | | - Kristen Underhill
- Associate professor, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York
| | - Caroline Kuo
- Associate professor (research), Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence
| | - Kate M. Guthrie
- Senior research, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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Saldanha N. Use of Short Acting Reversible Contraception in Adolescents: The Pill, Patch, Ring and Emergency Contraception. Curr Probl Pediatr Adolesc Health Care 2018; 48:333-344. [PMID: 30470471 DOI: 10.1016/j.cppeds.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Long acting reversible contraception (LARC) is the recommend form of birth control for adolescents by both the American Academy of Pediatrics and the American Congress of Obstetrics and Gynecology, but the majority of adolescents continue to use short acting reversible contraception (SARC) such as the oral contraceptive pill, vaginal ring, and transdermal patch. For this reason, it is important for medical providers to be familiar with how to prescribe and manage SARC in adolescents, paying particular attention to which patients are eligible to use them, which benefits the methods have outside of contraception, what side effects to be aware of, and special considerations for adolescents. Many adolescents will choose not to use any form of hormonal contraception-thus having a knowledge about and comfort with use of emergency contraception is of equal importance.
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Affiliation(s)
- Nadia Saldanha
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York, NY 11042, United State; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead, New York, United State.
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Kestelyn E, Van Nuil JI, Umulisa MM, Umutoni G, Uwingabire A, Mwambarangwe L, Uwineza M, Agaba S, Crucitti T, van de Wijgert J, Delvaux T. High acceptability of a contraceptive vaginal ring among women in Kigali, Rwanda. PLoS One 2018; 13:e0199096. [PMID: 29912906 PMCID: PMC6005526 DOI: 10.1371/journal.pone.0199096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 05/31/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Introduction of contraceptive vaginal rings (CVRs) could expand the contraceptive method mix reducing the unmet need for family planning in Rwanda, but data on acceptability of CVRs from low and middle-income countries are lacking. METHODS This study explores acceptability of contraceptive vaginal ring (NuvaRing) use in Kigali, Rwanda using a mixed methods approach. We collected quantitative and qualitative data before, during and after conducting a clinical trial, using Case Report Forms, Interviewer Administered Questionnaires, In Depth Interviews and Focus Group Discussions. We analyzed the data using an existing theoretical framework including product attributes, relationship attributes and sexual encounter attributes as well as the contextual environment. RESULTS Our data showed that initial worries reduced over time with actual ring use and ring insertions and removals were described as easy. Most women did not feel the ring during daily activities, appreciated the lack of perceived negative side effects and the increased lubrication. Relationship attributes and sexual encounter attributes such as sexual comfort played a significant role in ring acceptability of the participants and their partners. The contextual environment including Rwandan cultural norms around sexuality positively influenced the acceptance of the NuvaRing. Overall satisfaction was high. CONCLUSIONS Acceptability of the Nuvaring was high among study participants and represents a promising option that could contribute to lowering the unmet need for family planning in Rwanda.
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Affiliation(s)
- Evelyne Kestelyn
- Rinda Ubuzima, Kigali, Rwanda
- University of Liverpool, Institute of Infection and Global Health, Liverpool, United kingdom
| | - Jennifer Ilo Van Nuil
- Rinda Ubuzima, Kigali, Rwanda
- University of Liverpool, Institute of Infection and Global Health, Liverpool, United kingdom
| | | | | | | | | | | | | | | | - Janneke van de Wijgert
- University of Liverpool, Institute of Infection and Global Health, Liverpool, United kingdom
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14
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McLellan-Lemal E, Ondeng'e K, Gust DA, Desai M, Otieno FO, Madiega PA, Nyagol B, Makanga EM. Contraceptive vaginal ring experiences among women and men in Kisumu, Kenya: A qualitative study. ACTA ACUST UNITED AC 2017; 2. [PMID: 28845463 PMCID: PMC5568572 DOI: 10.15761/fwh.1000122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Future HIV prevention options for women will likely include Antiretroviral (ARV)-based intravaginal rings. Valuable insights may be gained by examining user experiences with a similar licensed technology, a contraceptive ring, especially in settings where this technology may not be currently available. Methods In-depth interviews with 24 females enrolled in a trial assessing acceptability and use of a contraceptive ring, and 20 male sexual partners were conducted September 2014–April 2015. Elements of ethnography and phenomenological anthropology were used to collect, analyze, interpret, and describe ring users’ experiences. Thematic analysis was completed in MaxQDA-10. Results Experiences with the contraceptive ring reflected a broader Family Planning (FP) paradigm that centered around three themes: latitudes and drawbacks of FP (being free); an FP method needs to be compatible with a woman’s body (feeling normal); and dealing with fertility control uncertainties (how well does it really work). FP intentions and disclosure practices were influenced by partner support, socioeconomic factors, religion, cultural beliefs, and societal norms, including female sexuality. A user-friendly FP design was emphasized. Non-suppression of menstruation was favored by most. Unease with vaginal insertion as well as ring placement issues (slippage, expulsion) created initial challenges requiring clinician assistance and practice for some participants. While minor side-effects were described, concerns centered on ring efficacy, negative effect on a woman’s sexual desire, and future fertility issues. Conclusions Awareness of the multiple contexts in ring users’ experience may inform the development, education, and promotion approaches for future ARV rings.
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Affiliation(s)
- E McLellan-Lemal
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia-USA
| | - K Ondeng'e
- Kenya Medical Research Institute, Kisumu, Kenya
| | - D A Gust
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia-USA
| | - M Desai
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia-USA
| | - F O Otieno
- Nyanza Reproductive Health Society, Kisumu, Keny
| | - P A Madiega
- Kenya Medical Research Institute, Kisumu, Kenya
| | - B Nyagol
- Kenya Medical Research Institute, Kisumu, Kenya
| | - E M Makanga
- Kenya Medical Research Institute, Kisumu, Kenya
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15
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Abstract
Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand.
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Affiliation(s)
- Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women's Health, Kapiolani Medical Center for Women and Children, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA.
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, Kapiolani Medical Center for Women and Children, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA
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16
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Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. JOURNAL OF SEX RESEARCH 2016; 53:417-56. [PMID: 26954608 PMCID: PMC4868075 DOI: 10.1080/00224499.2015.1134425] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.
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17
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18
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Nappi RE. Counseling on vaginal delivery of contraceptive hormones: implications for women's body knowledge and sexual health. Gynecol Endocrinol 2013; 29:1015-21. [PMID: 23992246 DOI: 10.3109/09513590.2013.830100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Healthcare providers (HCPs) have an important role in helping women select the contraceptive method that best matches their needs and lifestyle. Recent surveys outline the need of women to be informed about all available choices, including the newest methods (particularly those not requiring daily administration), such as vaginal contraception. METHODS The most relevant publications on combined contraceptive vaginal ring are revised in the context of counseling as an opportunity to empower women in term of vaginal health and sexual functioning. RESULTS HCPs should explain the main characteristics of the combined contraceptive vaginal ring including the anatomical and physiological implications that make the vagina an ideal route of hormonal administration and the basic notions about functional modifications of the vagina during reproductive life. Clinical data on the vaginal ring should be summarized with regard to efficacy, tolerability, pharmacokinetics, cycle control and user acceptability, including recent findings on extra-contraceptive benefits (also compared to other hormonal contraceptives) on the vaginal flora and on sexual function. CONCLUSION Vaginal contraception offers various benefits and should always be discussed during contraceptive counseling. An open dialogue about vaginal contraception will also help enhance body knowledge and sexual health.
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Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Obstetrics and Gynecology, Research Center for Reproductive Medicine, IRCCS San Matteo Foundation, University of Pavia , Pavia , Italy
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19
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The Optimization of an Intravaginal Ring Releasing Progesterone Using a Mathematical Model. Pharm Res 2013; 31:795-808. [DOI: 10.1007/s11095-013-1201-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/31/2013] [Indexed: 10/26/2022]
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20
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Williams RL, Fortenberry JD. Dual use of long-acting reversible contraceptives and condoms among adolescents. J Adolesc Health 2013; 52:S29-34. [PMID: 23535054 DOI: 10.1016/j.jadohealth.2013.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 02/02/2013] [Accepted: 02/04/2013] [Indexed: 12/17/2022]
Abstract
Unintended pregnancy and sexually transmitted infections (STI) continue to be significant public health problems, and adolescents are disproportionately affected by both. With national attention and funding directed toward adolescent pregnancy prevention, promotion of long-acting reversible contraceptive (LARC) use among adolescents is both timely and relevant. However, LARCs provide no protection against STIs, requiring dual-method use of both LARC and barrier methods, most commonly the male latex condom, to address these issues simultaneously. Rates of both LARC and dual-method contraception are low in the United States, but have increased in recent years. Dual-method contraception is highest among younger women and adolescents with multiple or new sex partners. Consistent condom use remains a major barrier to dual-method use, as it necessitates admission of STI risk by both partners, and use is dependent upon two decision-makers rather than a single contraceptive user. Promoting the initiation and maintenance of LARC and condom use across multiple partnered sexual encounters requires understanding of individual, dyadic, and social influences. Successful maintenance of contraceptive and STI prevention behaviors requires individualized, longitudinal reinforcement, and social supports, but can ultimately reduce the burden of unintended pregnancy and STI among adolescents.
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Affiliation(s)
- Rebekah L Williams
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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21
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Brache V, Payán LJ, Faundes A. Current status of contraceptive vaginal rings. Contraception 2012; 87:264-72. [PMID: 23040125 DOI: 10.1016/j.contraception.2012.08.037] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/26/2012] [Indexed: 11/18/2022]
Abstract
Contraceptive vaginal rings (CVR) offer a new, effective contraceptive option, expanding the available choices of hormonal contraception. Various ring prototypes have been evaluated: progestin-only rings and combined progestin-estrogen rings, as well as different combination of progestins and estrogens. The progestin-only ring is intended for continuous use, whereas the combined ring has been designed for cyclic 3-week in/1-week out use, although several studies have explored alternative schemes of extended use. However, only two ring designs have reached the market: NuvaRing, a 1-month combined ring that releases etonogestrel and ethinylestradiol, and Progering, a 3-month progesterone-releasing ring for use in lactating women. A one year Nestorone/ethinyl estradiol CVR is approaching the final stages of development, as the Population Council is preparing to submit a new drug application to the Food and Drug Administration. The main advantages of CVRs are their effectiveness (similar or slightly better than the pill), ease of use without the need of remembering a daily routine, user ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring, in comparison with oral contraceptives. Current prototypes in development include rings releasing progesterone receptor modulators, which would provide estrogen-free contraception, as well as combined rings releasing estradiol, instead of ethinyl-estradiol, providing a safer profile. Furthermore, intensive efforts towards developing dual protection rings, providing both contraception and protection against reproductive tract infections, offer hope that this greatly needed technology will soon undergo clinical testing and will be in the hands of women worldwide in the near future.
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Affiliation(s)
- Vivian Brache
- PROFAMILIA, P.O. Box 1053, Santo Domingo, Dominican Republic 10401.
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22
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Dehlendorf C, Foster DG, de Bocanegra HT, Brindis C, Bradsberry M, Darney P. Race, ethnicity and differences in contraception among low-income women: methods received by Family PACT Clients, California, 2001-2007. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2011; 43:181-7. [PMID: 21884386 PMCID: PMC3412526 DOI: 10.1363/4318111] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
CONTEXT The extent to which racial and ethnic differences in method choice are associated with financial barriers is unclear. Understanding these associations may provide insight into how to address racial and ethnic disparities in unintended pregnancy. METHODS Claims data from the California Family PACT program, which provides free family planning services to low-income residents, were used to determine the proportions of women receiving each type of contraceptive method in 2001-2007. Bivariate and multivariate analyses were performed to identify associations between women's race and ethnicity and the primary contraceptive method they received in 2007. RESULTS Compared with white women, blacks and Latinas were less likely to receive oral contraceptives (odds ratios, 0.4 and 0.6, respectively) and the contraceptive ring (0.7 and 0.5), and more likely to receive the injectable (1.6 and 1.4) and the patch (1.6 and 2.3). Black women were less likely than whites to receive the IUD (0.5), but more likely to receive barrier methods and emergency contraceptive pills (2.6); associations were similar, though weaker, for Latinas. Racial and ethnic disparities in receipt of effective methods declined between 2001 and 2005, largely because receipt of the patch (which was introduced in 2002) was higher among minority than white women. CONCLUSION Although Family PACT eliminates financial barriers to method choice, the methods women received differed substantially by race and ethnicity in this low-income population. The reduction in racial and ethnic disparities following introduction of the patch suggests that methods with novel characteristics may increase acceptability of contraceptives among minority women.
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Affiliation(s)
- Christine Dehlendorf
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, USA.
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23
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Huppert JS, Hesse EA, Bernard MA, Xiao Y, Huang B, Gaydos CA, Kahn JA. Acceptability of self-testing for trichomoniasis increases with experience. Sex Transm Infect 2011; 87:494-500. [PMID: 21795289 DOI: 10.1136/sextrans-2011-050037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Self-testing and point-of-care (POC) tests could improve the detection of sexually transmitted infections (STIs) in adolescents. This study aimed to (1) validate a scale measuring acceptability of self-testing for trichomoniasis, (2) compare acceptability of self versus clinician testing using a POC test for trichomoniasis, (3) examine changes in acceptability after experience and review of results, and (4) examine predictors of acceptability. METHODS Women (14-22 years old) performed the POC test and completed surveys assessing acceptability of self and clinician testing at baseline, after testing, and after discussion of results. Factor analysis examined scale structure; changes in mean scale scores were assessed with mixed models. Generalised linear models examined predictors of acceptability. RESULTS Of 247 participants, 54 (22%) had a positive POC test for trichomoniasis. Factor analysis confirmed four acceptability subscales: trust of results, confidence, comfort, and effects of testing. At baseline, trust and confidence were higher, and comfort was lower, for clinician versus self testing. For self-testing, all subscale scores increased from baseline to after testing, and trust increased from after testing to after discussion. Trust of self and clinician results was not significantly different after discussion. A positive attitude towards home testing predicted higher self-test acceptability on all subscales. Tampon use was associated with increased self-test comfort at baseline. Concordance between self and clinician results predicted increased trust of self testing after discussion. CONCLUSIONS Many young women lack confidence in their ability to self-test for trichomoniasis. Allowing women to try a POC test and review the results with a clinician increases acceptability of self-testing.
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Affiliation(s)
- Jill S Huppert
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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