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Nichols JH, Ali M, Anetor JI, Chen LS, Chen Y, Collins S, Das S, Devaraj S, Fu L, Karon BS, Kary H, Nerenz RD, Rai AJ, Shajani-Yi Z, Thakur V, Wang S, Yu HYE, Zamora LE. AACC Guidance Document on the Use of Point-of-Care Testing in Fertility and Reproduction. J Appl Lab Med 2022; 7:1202-1236. [DOI: 10.1093/jalm/jfac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The AACC Academy revised the reproductive testing section of the Laboratory Medicine Practice Guidelines: Evidence-Based Practice for Point-of-Care Testing (POCT) published in 2007.
Methods
A panel of Academy members with expertise in POCT and laboratory medicine was formed to develop guidance for the use of POCT in reproductive health, specifically ovulation, pregnancy, premature rupture of membranes (PROM), and high-risk deliveries. The committee was supplemented with clinicians having Emergency Medicine and Obstetrics/Gynecology training.
Results
Key recommendations include the following. First, urine luteinizing hormone (LH) tests are accurate and reliable predictors of ovulation. Studies have shown that the use of ovulation predicting kits may improve the likelihood of conception among healthy fertile women seeking pregnancy. Urinary LH point-of-care testing demonstrates a comparable performance among other ovulation monitoring methods for timing intrauterine insemination and confirming sufficient ovulation induction before oocyte retrieval during in vitro fertilization. Second, pregnancy POCT should be considered in clinical situations where rapid diagnosis of pregnancy is needed for treatment decisions, and laboratory analysis cannot meet the required turnaround time. Third, PROM testing using commercial kits alone is not recommended without clinical signs of rupture of membranes, such as leakage of amniotic fluid from the cervical opening. Finally, fetal scalp lactate is used more than fetal scalp pH for fetal acidosis due to higher success rate and low volume of sample required.
Conclusions
This revision of the AACC Academy POCT guidelines provides recommendations for best practice use of POCT in fertility and reproduction.
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Affiliation(s)
| | | | | | | | - Yu Chen
- Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Dalhousie University, and Memorial University , Fredericton, NB , Canada
| | - Sean Collins
- Vanderbilt University Medical Center , Nashville, TN , USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System , Nashville, TN , USA
| | - Saswati Das
- Dr. Ram Manohar Lohia Hospital, Atal Bihari Vajpayee Institute of Medical Sciences , New Delhi , India
| | - Sridevi Devaraj
- Texas Children’s Hospital and Baylor College of Medicine , Houston, TX , USA
| | - Lei Fu
- Sunnybrook Health Sciences Center , Toronto, ON , Canada
| | | | - Heba Kary
- King Fahd Armed Forces Hospital , Jeddah , Saudi Arabia
| | | | - Alex J Rai
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital , New York, NY , USA
| | - Zahra Shajani-Yi
- Laboratory Corporation of America (LabCorp) , San Diego, CA, USA
| | - Vinita Thakur
- Eastern Health Authority, Health Science Center and Memorial University , St. John’s, NL , Canada
| | - Sihe Wang
- Akron Children’s Hospital , Akron, OH , USA
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Gorczyca AM, Steger FL, Ptomey LT, Montgomery RN, Mickelsen R, Smith P, Donnelly JE, Marsh CA. The impact of a group based, remotely delivered weight loss intervention in women with polycystic ovary syndrome on ovulation, quality of life and body composition. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:940945. [PMID: 36303658 PMCID: PMC9580823 DOI: 10.3389/frph.2022.940945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Obesity and visceral adiposity are associated with anovulation. The most common cause of anovulatory infertility in women of reproductive age is polycystic ovary syndrome (PCOS). We conducted this formative study to examine the effects of a remotely delivered, group-based lifestyle program for women with overweight/obesity and PCOS on ovulation, PCOS related quality of life (PCOSQ) and body composition. Methods Women with anovulatory infertility caused by PCOS (N = 12) were enrolled in a 6-month high-intensity weight management intervention. Participants were asked to attend 45 min., group behavioral lifestyle sessions, delivered remotely by a registered dietitian weekly across the 6-mo. study and comply with a reduced energy diet, increased physical activity (225 min/wk.), and self-monitoring of weight, physical activity and diet. Diets consisted of five portion-controlled meals (three shakes + two entrees), at least five servings of fruits/vegetables, and ad libitum non-caloric beverages daily. Wilcoxon signed-rank tests were used to assess changes in outcomes across the intervention. Results Twelve women received the weight loss intervention (mean age = 32.7 ± 4.2 yrs., BMI = 36.8 ± 4.5 kg/m2, 92% college educated), and 8 completed the intervention. Eight (67%) women reported ovulating during the intervention with an average time to ovulation of 57 ± 45 days. Women lost an average of 3.85 ± 5.94 kg (p = 0.02), decreased their BMI (−1.61 ± 1.09 kg/m2; p = 0.04), and waist circumference (−4.54 ± 3.03 cm; p = 0.04) over the 6-mo. intervention. Additionally, self-reported menstrual problems measured by PCOSQ significantly improved over the study (p = 0.03). Conclusion A multicomponent group-based, remotely delivered, lifestyle intervention delivered remotely is a feasible and potentially scalable option to achieve clinically relevant (>3%) weight loss in women with PCOS. Clinical trial registration www.clinicaltrials.gov, identifier: NCT03677362.
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
- *Correspondence: Anna M. Gorczyca
| | - Felicia L. Steger
- Division of Endocrinology, Diabetes and Clinical Pharmacology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Lauren T. Ptomey
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Robert N. Montgomery
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Riley Mickelsen
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Patricia Smith
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Courtney A. Marsh
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, MO, United States
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B. S. H, K. D, R. C. M, T. G. K, A. P. Novel Technique for Confirmation of the Day of Ovulation and Prediction of Ovulation in Subsequent Cycles Using a Skin-Worn Sensor in a Population With Ovulatory Dysfunction: A Side-by-Side Comparison With Existing Basal Body Temperature Algorithm and Vaginal Core Body Temperature Algorithm. Front Bioeng Biotechnol 2022; 10:807139. [PMID: 35309997 PMCID: PMC8931469 DOI: 10.3389/fbioe.2022.807139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Determine the accuracy of a novel technique for confirmation of the day of ovulation and prediction of ovulation in subsequent cycles for the purpose of conception using a skin-worn sensor in a population with ovulatory dysfunction. Methods: A total of 80 participants recorded consecutive overnight temperatures using a skin-worn sensor at the same time as a commercially available vaginal sensor for a total of 205 reproductive cycles. The vaginal sensor and its associated algorithm were used to determine the day of ovulation, and the ovulation results obtained using the skin-worn sensor and its associated algorithm were assessed for comparative accuracy alongside a number of other statistical techniques, with a further assessment of the same skin-derived data by means of the "three over six" rule. A number of parameters were used to divide the data into separate comparative groups, and further secondary statistical analyses were performed. Results: The skin-worn sensor and its associated algorithm (together labeled "SWS") were 66% accurate for determining the day of ovulation (±1 day) or the absence of ovulation and 90% accurate for determining the fertile window (ovulation day ±3 days) in the total study population in comparison to the results obtained from the vaginal sensor and its associated algorithm (together labeled "VS"). Conclusion: SWS is a useful tool for confirming the fertile window and absence of ovulation (anovulation) in a population with ovulatory dysfunction, both known and determined by means of the timing of ovulation. The body site where the skin-worn sensor was worn (arm or wrist) did not appear to affect the accuracy. Prior diagnosis of known causes of ovulatory dysfunction appeared to affect the accuracy to a lesser extent than those cycles grouped into late ovulation and "early and normal ovulation" groups. SWS is a potentially useful tool for predicting ovulation in subsequent cycles, with greater accuracy obtained for the "normal ovulation" group.
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Affiliation(s)
- Hurst B. S.
- Carolinas Medical Center, Department of Assisted Reproduction, Charlotte, NC, United States
| | - Davies K.
- Independent Fertility Nurse Consultant and Coach, Castle Bytham, United Kingdom
| | - Milnes R. C.
- Fertility Focus Inc. (Now viO HealthTech Inc.), Old Saybrook, CT, United States
| | - Knowles T. G.
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Pirrie A.
- Fertility Focus Limited (now viO HealthTech Limited), Basepoint Business Centre, Warwick, United Kingdom
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Goeckenjan M, Schiwek E, Wimberger P. Continuous Body Temperature Monitoring to Improve the Diagnosis of Female Infertility. Geburtshilfe Frauenheilkd 2020; 80:702-712. [PMID: 32675832 PMCID: PMC7360395 DOI: 10.1055/a-1191-7888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022] Open
Abstract
Introduction Ovulatory dysfunction is a major cause of female infertility. We evaluated the use of continuous body temperature monitoring with a vaginal biosensor to improve standard diagnostic procedures for determining ovulatory dysfunction. Material and Methods This prospective interventional study was performed in a reproductive medicine department of a university hospital. The menstrual cycles of 51 women with infertility were monitored and analysed using three different strategies: sonographic and hormonal assessment (standard approach), continuous core body temperature measurement and analysis using the algorithm of OvulaRing, and lowest daily body temperature measurement monitored with a vaginal biosensor and analysed based on the body temperature curves used in natural family planning. Results Statistically significant differences were found in the temperature curves of women with luteal phase deficiency and polycystic ovary syndrome compared to women with normal menstrual cycles. The analysis of individual cyclofertilograms can be used to detect cycle phases and estimate the date of ovulation. Conclusions Continuous body temperature monitoring with a vaginal biosensor can improve the standard diagnostic procedures used to determine ovulatory dysfunction, especially if dysfunction is due to luteal phase deficiency and polycystic ovary syndrome. Analysis of the lowest daily body temperature combined with the basal body temperature measurements used in fertility awareness methods may be equieffective to continuous body temperature measurements with OvulaRing. The results of this study show that a revised diagnostic approach using fewer hormonal assessments combined with continuous body temperature monitoring can reduce the number of appointments in an infertility clinic as well as the costs.
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Affiliation(s)
- Maren Goeckenjan
- TU Dresden, Department for Gynecology and Obstetrics, Dresden, Germany
| | - Esther Schiwek
- TU Dresden, Department for Gynecology and Obstetrics, Dresden, Germany
| | - Pauline Wimberger
- TU Dresden, Department for Gynecology and Obstetrics, Dresden, Germany
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Baker FC, Siboza F, Fuller A. Temperature regulation in women: Effects of the menstrual cycle. Temperature (Austin) 2020; 7:226-262. [PMID: 33123618 PMCID: PMC7575238 DOI: 10.1080/23328940.2020.1735927] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 02/08/2023] Open
Abstract
Core body temperature changes across the ovulatory menstrual cycle, such that it is 0.3°C to 0.7°C higher in the post-ovulatory luteal phase when progesterone is high compared with the pre-ovulatory follicular phase. This temperature difference, which is most evident during sleep or immediately upon waking before any activity, is used by women as a retrospective indicator of an ovulatory cycle. Here, we review both historical and current literature aimed at characterizing changes in core body temperature across the menstrual cycle, considering the assessment of the circadian rhythm of core body temperature and thermoregulatory responses to challenges, including heat and cold exposure, exercise, and fever. We discuss potential mechanisms for the thermogenic effect of progesterone and the temperature-lowering effect of estrogen, and discuss effects on body temperature of exogenous formulations of these hormones as contained in oral contraceptives. We review new wearable temperature sensors aimed at tracking daily temperature changes of women across multiple menstrual cycles and highlight the need for future research on the validity and reliability of these devices. Despite the change in core body temperature across the menstrual cycle being so well identified, there remain gaps in our current understanding, particularly about the underlying mechanisms and microcircuitry involved in the temperature changes.
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Affiliation(s)
- Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, USA
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Felicia Siboza
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea Fuller
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ng KYB, Mingels R, Morgan H, Macklon N, Cheong Y. In vivo oxygen, temperature and pH dynamics in the female reproductive tract and their importance in human conception: a systematic review. Hum Reprod Update 2018; 24:15-34. [PMID: 29077897 DOI: 10.1093/humupd/dmx028] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/15/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite advances in ART, implantation and pregnancy rates per embryo transfer still remain low. IVF laboratories strive to ensure that the process of handling gametes in vitro closely mimics the in vivo environment. However, there remains a lack of knowledge regarding the in vivo regulation and dynamic variation in biophysical parameters such as oxygen concentration, pH and temperature within the reproductive tract. OBJECTIVE AND RATIONALE To undertake a systematic review of the current understanding of the physico-chemical parameters of oxygen tension (pO2), pH and temperature within the female reproductive tract, and their potential implications in clinical and pathological processes related to fertility and those pertaining to limited reproductive capacity. SEARCH METHODS A comprehensive literature search was performed using electronic databases including Medline, Embase, Cochrane Library and Pubmed to identify original and review articles addressing the biophysical parameters (pO2, pH and temperature) in the female reproductive tract of any species. The search included all studies published between 1946 and November 2015. Search terms included 'oxygen', 'pH', 'hydrogen ion concentration', 'acid base' and others terms. We also used special features and truncations to identify synonyms and broaden the search. Studies were excluded if they only assessed embryo culture conditions, fetal acid-base status, oxidative stress, outcomes of pregnancy and measurements of these parameters in non-reproductive organs. OUTCOMES Our search generated 18 685 records and 60 articles were included. pO2 within the female reproductive tract shows cyclical variation and minute-to-minute oscillations, which may be influenced by uterine contractility, hormones, the autonomic system, cardiac pulsatility, and myometrial and smooth muscle integrity. Fine balanced control of pO2 and avoidance of overwhelming oxidative stress is crucial for embryogenesis and implantation. The pH in the female reproductive tract is graduated, with lowest pH in the vagina (~pH 4.42) increasing toward the Fallopian tubes (FTs) (~pH 7.94), reflecting variation in the site-specific microbiome and acid-base buffering at the tissue/cellular level. The temperature variation in humans is cyclical by day and month. In humans, it is biphasic, increasing in the luteal phase; with the caudal region of the oviduct 1-2 degrees cooler than the cranial portion. Temperature variation is influenced by hormones, density of pelvic/uterine vascular beds and effectiveness of heat exchange locally, crucial for sperm motility and embryo development. We have identified significant deficiencies and inconsistencies in the methods used to assess these biophysical factors within the reproductive tract. We have suggested that the technological solutions including the development of methods and models for real time, in vivo recordings of biophysical parameters. WIDER IMPLICATIONS The notion of 'back to nature' in assisted conception suggested 20 years ago has yet to be translated into clinical practice. While the findings from this systematic review do not provide evidence to change current in vitro protocols, it highlights our current inability to assess the in vivo reproductive tract environment in real time. Data made available through future development of sensing technology in utero may help to provide new insights into how best to optimize the in vitro embryo environment and allow for more precise and personalized fertility treatment.
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Affiliation(s)
- Ka Ying Bonnie Ng
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.,Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton SO16 5YA, UK
| | - Roel Mingels
- Department of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Hywel Morgan
- Department of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Nick Macklon
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.,Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton SO16 5YA, UK
| | - Ying Cheong
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.,Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton SO16 5YA, UK.,Complete Fertility Centre Southampton, Princess Anne Hospital Coxford Road, Southampton SO16 5YA, UK
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Su HW, Yi YC, Wei TY, Chang TC, Cheng CM. Detection of ovulation, a review of currently available methods. Bioeng Transl Med 2017; 2:238-246. [PMID: 29313033 PMCID: PMC5689497 DOI: 10.1002/btm2.10058] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 11/15/2022] Open
Abstract
The ability to identify the precise time of ovulation is important for women who want to plan conception or practice contraception. Here, we review the current literature on various methods for detecting ovulation including a review of point‐of‐care device technology. We incorporate an examination of methods to detect ovulation that have been developed and practiced for decades and analyze the indications and limitations of each—transvaginal ultrasonography, urinary luteinizing hormone detection, serum progesterone and urinary pregnanediol 3‐glucuronide detection, urinary follicular stimulating hormone detection, basal body temperature monitoring, and cervical mucus and salivary ferning analysis. Some point‐of‐care ovulation detection devices have been developed and commercialized based on these methods, however previous research was limited by small sample size and an inconsistent standard reference to true ovulation.
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Affiliation(s)
- Hsiu-Wei Su
- Dept. of Obstetrics, Gynecology & Women's Health Taichung Veterans General Hospital Taichung Taiwan
| | - Yu-Chiao Yi
- Dept. of Obstetrics, Gynecology & Women's Health Taichung Veterans General Hospital Taichung Taiwan
| | - Ting-Yen Wei
- Interdisciplinary Program of Life Science National Tsing Hua University Hsinchu Taiwan
| | - Ting-Chang Chang
- Div. of Gynecologic Oncology, Dept. of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University Hsinchu Taiwan
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Biomarkers and biometric measures of adherence to use of ARV-based vaginal rings. J Int AIDS Soc 2016; 19:20746. [PMID: 27142091 PMCID: PMC4854848 DOI: 10.7448/ias.19.1.20746] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/21/2016] [Accepted: 03/31/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Poor adherence to product use has been observed in recent trials of antiretroviral (ARV)-based oral and vaginal gel HIV prevention products, resulting in an inability to determine product efficacy. The delivery of microbicides through vaginal rings is widely perceived as a way to achieve better adherence but vaginal rings do not eliminate the adherence challenges exhibited in clinical trials. Improved objective measures of adherence are needed as new ARV-based vaginal ring products enter the clinical trial stage. Methods To identify technologies that have potential future application for vaginal ring adherence measurement, a comprehensive literature search was conducted that covered a number of biomedical and public health databases, including PubMed, Embase, POPLINE and the Web of Science. Published patents and patent applications were also searched. Technical experts were also consulted to gather more information and help evaluate identified technologies. Approaches were evaluated as to feasibility of development and clinical trial implementation, cost and technical strength. Results Numerous approaches were identified through our landscape analysis and classified as either point measures or cumulative measures of vaginal ring adherence. Point measurements are those that give a measure of adherence at a particular point in time. Cumulative measures attempt to measure ring adherence over a period of time. Discussion Approaches that require modifications to an existing ring product are at a significant disadvantage, as this will likely introduce additional regulatory barriers to the development process and increase manufacturing costs. From the point of view of clinical trial implementation, desirable attributes would be high acceptance by trial participants, and little or no additional time or training requirements on the part of participants or clinic staff. We have identified four promising approaches as being high priority for further development based on the following measurements: intracellular drug levels, drug levels in hair, the accumulation of a vaginal analyte that diffuses into the ring, and the depletion of an intrinsic ring constituent. Conclusions While some approaches show significant promise over others, it is recommended that a strategy of using complementary biometric and behavioural approaches be adopted to best understand participants’ adherence to ARV-based ring products in clinical trials.
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