Montgomery Elizabeth T, van der Straten Ariane, Chitukuta Miria, Reddy Krishnaveni, Woeber Kubashni, Atujuna Millicent, Bekker Linda-Gail, Etima Juliane, Nakyanzi Teopista, Mayo Ashley J, Katz Ariana, Laborde Nicole, Grossman Cynthia I, Soto-Torres Lydia, Palanee-Phillips Thesla, Baeten Jared M
aWomen's Global Health Imperative, RTI International bDepartment of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, California, USA cUZ-UCSF Collaborative Research Programme, Harare, Zimbabwe dWits Reproductive Health and HIV Institute (WRHI), Johannesburg eHIV Prevention Research Unit, South Africa Medical Research Council, Durban fDesmond Tutu HIV Research Centre, Cape Town, South Africa gMakerere University-Johns Hopkins University Research Unit, Kampala, Uganda hFHI360, Durham, North Carolina iNational Institute of Mental Health jDivision of AIDS, NIH, Bethesda, Maryland kUniversity of Washington, Seattle, Washington, USA.
AIDS. 2017 May 15;31(8):1159-1167. doi: 10.1097/QAD.0000000000001452.
The MTN-020/ASPIRE trial evaluated the safety and effectiveness of the dapivirine vaginal ring for prevention of HIV-1 infection among African women. A nested qualitative component was conducted at six of 15 study sites in Uganda, Malawi, Zimbabwe and South Africa to evaluate acceptability of and adherence to the ring.
Qualitative study participants (n = 214) were interviewed with one of three modalities: single in-depth interview, up to three serial interviews or an exit Focus Group Discussion. Using semistructured guides administered in local languages, 280 interviews were audio-recorded, transcribed, translated, coded and analyzed.
We identified three key findings: first, despite initial fears about the ring's appearance and potential side effects, participants grew to like it and developed a sense of ownership of the ring once they had used it. Second, uptake and sustained adherence challenges were generally overcome with staff and peer support. Participants developed gradual familiarity with ring use through trial progression, and most reported that it was easy to use and integrate into their lives. Using the ring in ASPIRE was akin to joining a team and contributing to a broader, communal good. Third, the actual or perceived dynamics of participants' male partner relationship(s) were the most consistently described influence (which ranged from positive to negative) on participants' acceptability and use of the ring.
It is critical that demonstration projects address challenges during the early adoption stages of ring diffusion to help achieve its potential public health impact as an effective, long-acting, female-initiated HIV prevention option addressing women's disproportionate HIV burden.
MTN - 020/ASPIRE试验评估了达匹韦林阴道环预防非洲女性感染HIV - 1的安全性和有效性。在乌干达、马拉维、津巴布韦和南非的15个研究地点中的6个开展了一项嵌套式定性研究，以评估对该阴道环的可接受性和依从性。
对定性研究参与者（n = 214）采用以下三种方式之一进行访谈：单次深入访谈、最多三次系列访谈或结束时的焦点小组讨论。使用以当地语言进行的半结构化指南，对280次访谈进行了录音、转录、翻译、编码和分析。
我们确定了三个关键发现：第一，尽管最初担心阴道环的外观和潜在副作用，但参与者一旦使用后就逐渐喜欢上它，并产生了对该阴道环的主人翁意识。第二，在工作人员和同伴的支持下，一般克服了使用和持续依从方面的挑战。参与者通过试验进展逐渐熟悉了阴道环的使用，大多数人报告说它易于使用且能融入他们的生活。在ASPIRE试验中使用阴道环类似于加入一个团队并为更广泛的公共利益做出贡献。第三，参与者男性伴侣关系的实际或感知动态是对参与者对阴道环的可接受性和使用最一致描述的影响因素（范围从积极到消极）。
至关重要的是，示范项目要应对阴道环推广早期采用阶段的挑战，以帮助实现其作为一种有效、长效、由女性主动采取的HIV预防选择的潜在公共卫生影响，从而解决女性不成比例的HIV负担问题。
