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. 2024 May 31;24(1):1458.
doi: 10.1186/s12889-024-18795-1.

Self-reported removal and expulsion of the dapivirine vaginal ring: qualitative reports from female ring users and their male partners in the Ring Study (IPM 027)

Cecilia Milford  1   2 , Hariska Ramlal  3 , Rorisang Mofokeng  3 , Letitia Rambally Greener  3 , Annaléne Nel  4 , Jennifer Smit  3 , Mariëtte Malherbe  4
Affiliations

Self-reported removal and expulsion of the dapivirine vaginal ring: qualitative reports from female ring users and their male partners in the Ring Study (IPM 027)

Cecilia Milford et al. BMC Public Health. .

Abstract

Background/aims: The dapivirine vaginal ring is a self-administered, women-initiated, discreet, long-acting HIV-1 prevention option for women. It was found to be safe and effective in healthy HIV-negative women who adhered to product use instructions, and has been approved for use in women aged 18 and older in some African countries. A qualitative study was conducted to explore participants' and their male partners' discussions on accidental/purposeful vaginal ring removals during The Ring Study (IPM 027 clinical trial).

Methods: Data were collected via in-depth interviews and focus group discussions with female trial participants and their male partners, from seven research centres in South Africa and Uganda. Data were thematically analysed using NVivo.

Results: More participants reported purposeful ring removals than accidental expulsions. Various factors influenced purposeful ring removal - including individual (discomfort during use/sex and to clean it), partner (to show them, because of discomfort during sex, to test if partners could feel it, and concerns of harm), organisational (doctor's request), and socio-cultural (rumours about sickness and infertility). Some described their own ring use removal, others discussed why other participants removed their rings.

Conclusions: Vaginal ring adherence is critical to improve and support product efficacy. Counselling on vaginal anatomy, vaginal ring insertion and importance of adherence is important to minimise vaginal ring removal. Couples counselling is also important to facilitate support and long-term vaginal ring adherence behaviour. Understanding factors influencing vaginal ring adherence is important for tailoring and targeting messages to support correct and consistent vaginal ring use as it is made available to the public.

Keywords: Adherence; Dapivirine; Expulsion; HIV prevention; Male partners; Ring removal; Sub-Saharan Africa; Vaginal ring.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Framework of adherence and factors influencing adherence [18]
See this image and copyright information in PMC

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References

    1. Griffin JB, Ridgeway K, Montgomery E, Torjesen K, Clark R, Peterson J et al. Vaginal ring acceptability and related preferences among women in low- and middle-income countries: a systematic review and narrative synthesis. PLoS ONE. 2019;14. - PMC - PubMed
    1. Alexander NJ, Baker E, Kaptein M, Karck U, Miller L, Zampaglione E. Why consider vaginal drug administration? Fertil Steril. 2004;82(1):1–12. doi: 10.1016/j.fertnstert.2004.01.025. - DOI - PubMed
    1. Roberts ST, Hawley I, Luecke E, Mensch B, Wagner T, Hoesley C, et al. Acceptability and preference for 3-month versus 1-month vaginal rings for HIV-1 risk reduction among participants in a phase 1 trial. J Women’s Health. 2022;31(7):1029–39. doi: 10.1089/jwh.2021.0121. - DOI - PMC - PubMed
    1. 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. 2021;106:16–33. doi: 10.1016/j.contraception.2021.10.001. - DOI - PMC - PubMed
    1. Montgomery ET, Beksinska M, Mgodi N, Schwartz K, Weinrib R, Brown EN, et al. End-user preference for and choice of four vaginally delivered HIV prevention methods among young women in South Africa and Zimbabwe: the Quatro clinical crossover study. J Int AIDS Soc. 2019;22:e25283. doi: 10.1002/jia2.25283. - DOI - PMC - PubMed

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