Women's Global Health Imperative, RTI International, San Francisco, CA, USA.
Makerere University-Johns Hopkins University Research Unit, Kampala, Uganda.
BMC Womens Health. 2021 Apr 23;21(1):175. doi: 10.1186/s12905-021-01321-5.
Clinical trials have found that a monthly dapivirine vaginal ring was well-tolerated and reduced HIV-1 risk among women in sub-Saharan Africa. However, in order for the ring or other novel prevention methods to have optimal impact, it is necessary to understand and address women's challenges to uptake and adherence. This paper provides insight into a few key challenges noted by women using the ring and contraceptives simultaneously.
The qualitative portion of the MTN-020/ASPIRE study consisted of data collection using single in-depth interviews, serial in-depth interviews, and focus group discussions, conducted with 214 participants across 15 sites in Malawi, South Africa, Uganda and Zimbabwe. A coding team used qualitative analysis software to identify themes within the interviews.
The primary qualitative themes among participant data pertained to side effects. Participants reported negative side effects related to menses, in some cases attributing these effects to their contraceptives and in others to the vaginal ring. Participants also expressed concern over the long-term impact of contraception and ring use on fertility, including the reversibility of the contraceptive, especially among nulliparous women.
Women's attitudes toward contraceptives can impact their willingness to concurrently use and adhere to a novel HIV prevention product. To optimize the potential of both prevention products, researchers should pre-emptively address concerns about contraceptive impact on fertility and counsel women about the expected side effects of contraceptives versus the ring. Clinical trials identifier NCT01617096. Registered on 6-12-2012 at clinicaltrials.gov https://clinicaltrials.gov/ct2/show/NCT01617096.
临床试验发现，每月使用一次的地匹福林阴道环在撒哈拉以南非洲地区的女性中耐受性良好，并降低了艾滋病毒 1 型的感染风险。然而，为了使阴道环或其他新型预防方法产生最佳效果，有必要了解和解决女性在使用这些方法时所面临的挑战。本文介绍了同时使用阴道环和避孕药的女性所遇到的一些关键挑战。
MTN-020/ASPIRE 研究的定性部分包括使用单深入访谈、系列深入访谈和焦点小组讨论收集数据，在马拉维、南非、乌干达和津巴布韦的 15 个地点共对 214 名参与者进行了研究。一个编码小组使用定性分析软件来确定访谈中的主题。
参与者数据中的主要定性主题与副作用有关。参与者报告了与月经相关的负面副作用，在某些情况下，她们将这些副作用归因于避孕药，而在其他情况下则归因于阴道环。参与者还对长期使用避孕药和阴道环对生育能力的影响表示担忧，包括避孕药的可逆性，尤其是对未生育的女性。
女性对避孕药的态度会影响她们同时使用和坚持使用新型 HIV 预防产品的意愿。为了最大限度地发挥这两种预防产品的潜力，研究人员应该预先解决关于避孕药对生育能力影响的担忧，并就避孕药与阴道环的预期副作用对女性进行咨询。临床试验标识符：NCT01617096。于 2012 年 12 月 6 日在 clinicaltrials.gov 注册，网址为 https://clinicaltrials.gov/ct2/show/NCT01617096。
