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Kestelyn E, Van Nuil JI, Umulisa MM, Umutoni G, Uwingabire A, De Baetselier I, Uwineza M, Agaba S, Crucitti T, Delvaux T, van de Wijgert JHHM. High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda. Front Glob Womens Health 2024; 5:1278981. [PMID: 38680542 PMCID: PMC11047128 DOI: 10.3389/fgwh.2024.1278981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background The introduction of female-initiated drug-delivery methods, including vaginal rings, have proven to be a promising avenue to address sexually transmitted infections and unintended pregnancies, which disproportionally affects women and girls in sub-Saharan Africa. Efficient uptake of existing and new technologies such as vaginal rings requires in depth understanding of product adherence. This remains a major challenge as data on adherence to vaginal rings from African countries is limited. In this study, we explored adherence of contraceptive vaginal ring (NuvaRing®) use in Kigali, Rwanda using a mixed methods approach. Methods We collected quantitative and qualitative data at multiple time points from women participating in a clinical trial exploring the safety and acceptability of either intermittent or continuous use of the NuvaRing®. Various adherence categories were used including monthly and cumulative adherence measurement. The quantitative data were analysed using R and the qualitative data were analysed using a deductive, content-analytical approach based on categories related to the quantitative adherence measures. All data were compared and triangulated. Results Data from 120 enrolled participants showed that self-reported adherence was high at every study visit in both study groups. At first study visit 80% of the intermittent ring users and 79.7% of the continuous ring users reported perfect adherence (assessed as "the ring was never out"). Reporting of ring expulsions and removals were highest (28.3%) at the beginning of the trial. Self-reported perfect ring adherence increased during the study and reports of ring expulsions and removals declined as familiarity with this contraceptive method increased. The percentage of women with perfect cumulative adherence was non-significantly higher in the intermittent (61.7%) than in the continuous use group (54.3%). The low rate of discrepant adherence data after triangulation (6%) is in line with the perception of the participants as adherent throughout the study. Conclusions Self-reported adherence in both study groups was high with removals and expulsions being within the expected product range. Comprehensive adherence data triangulation allowed for a deeper understanding of context-driven behaviour that shaped adherence patterns and challenges. Our data categorisation and triangulation approach has shown potential for implementation in future vaginal ring studies aiming to better understand and measure adherence.
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Affiliation(s)
- Evelyne Kestelyn
- Rinda Ubuzima, Kigali, Rwanda
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer Ilo Van Nuil
- Rinda Ubuzima, Kigali, Rwanda
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Janneke H. H. M. van de Wijgert
- Rinda Ubuzima, Kigali, Rwanda
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Salehjawich A, Günther V, Ruchay Z, Al Zoubi MS, Dhanawat J, Maass N, Ackermann J, Pape J, Alkatout I. Robot-Assisted Tubal Reanastomosis after Sterilization: A Choice for Family Planning. J Clin Med 2022; 11:4385. [PMID: 35956002 PMCID: PMC9369034 DOI: 10.3390/jcm11154385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022] Open
Abstract
A variety of procedures have been used for family planning. One of these is sterilization surgery, which can be reversed by a tubal reanastomosis. In the present report, we compare Robot-assisted tubal reanastomosis sterilization with other methods of family planning and discuss factors related to the choice of the approach. The keywords used for the electronic search in PubMed were family planning, sterilization, Robot-assisted, tubal reanastomosis, depression, and regret. The decision in favor of or against sterilization surgery has been a sensitive issue for several years. Robot-assisted technology is a modern and precise approach. It has contributed to the flexibility of the decision between sterilization and its reversal through tubal reanastomosis, as well as enhanced the success rate of the surgery. Based on our analysis of the published literature, we believe that Robot-assisted tubal anastomosis is the optimum approach. However, to ensure the quality of health care, the surgeon must be well trained, well versed with the anatomy of the fallopian tubes, and thoroughly informed on the psychological impact of family planning.
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Affiliation(s)
- Arwa Salehjawich
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Veronika Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Zino Ruchay
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Mazhar Salim Al Zoubi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 211-63, Jordan;
| | - Juhi Dhanawat
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Johannes Ackermann
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Julian Pape
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3 (House C), 24105 Kiel, Germany; (A.S.); (V.G.); (Z.R.); (J.D.); (N.M.); (J.A.); (J.P.)
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