Perspectives from Young South African and Zimbabwean Women on Attributes of Four (Placebo) Vaginal Microbicide Delivery Forms

Abstract

Introduction: Incorporating end-user input into the design of new vaginal microbicides for women is key to optimizing their uptake, consistent use, and, ultimately, success in combatting the heterosexual HIV epidemic.

Methods: The Quatro Study assessed four placebo forms of vaginally inserted HIV-microbicides among young microbicide-naïve African women: on-demand film, insert and gel, and monthly ring. Participants randomly used each product for 1 month and provided product satisfaction ratings (1-5 scale), and opinions on product attributes and potential alternative designs. Qualitative data were collected through focus group discussions at study exit. Multivariable associations between attribute opinions and overall product rating were examined using Poisson regression models with robust standard errors to assess the attributes most influential to satisfaction.

Results: Overall opinions of products and their individual attributes were generally positive; all products were rated either 4 or a 5 by ≥ 50% of participants. Attributes related to ease of use and interference with normal activities were the most salient predictors of satisfaction. Preferences for duration of use tended toward relatively shorter use periods for the ring (i.e., 1-3 months vs. 12 months) and for coitally independent dosing for the on-demand products.

Conclusions: How well a product fit in with participants' lifestyles was important to their overall satisfaction. For on-demand products, greater flexibility around timing of use was desired, to avoid coital dependency of the dosing.

Keywords: Acceptability; Africa; African women; End-user research; HIV prevention; Microbicides; Product attributes.

Fig. 1

Quatro Study vaginal products: ring, insert, film, gel. Placebo vaginal delivery forms used in the Quatro Study: a polyurethane ring, a water-based vaginal insert or tablet, a dry gel film, and hydroxyethyl cellulose (HEC) gel (inside an applicator). Additional details on product size: The ring is 55.0 mm in diameter, with a cross-sectional diameter of 5.5 mm. The insert is approximately 7 mm × 15 mm. The film has dimensions of approximately 5 cm × 5 cm, with an approximate thickness of 100–120 µm. The gel applicator contains approximately 4 ml of gel

Fig. 2

Distributions of Quatro product satisfaction ratings after 1 month of use (1 = disliked very much; 5 = liked very much). ¹The distribution of ratings for the film differed significantly by country (p < 0.001)