Abstract
Unprotected heterosexual intercourse is the leading cause of HIV acquisition in women. Due to the complex nature of correct and consistent condom use by both men and women, developing alternative female-controlled HIV prevention options is a global health priority. Vaginal films containing antiretroviral drugs are a potential delivery system for the prevention of HIV acquisition through sexual contact. In this study, we explored women’s preferences regarding physical characteristics of microbicide vaginal films through questionnaires and focus groups. Eighty-four sexually active, ethnically diverse women 18–30 years of age from Pittsburgh, Pennsylvania, participated in the study. Women visually and manually examined a variety of vaginal films, as well as three other vaginal products undergoing evaluation for HIV prevention: tablet, ring, and gel. Means and standard deviations or frequencies and 95 % confidence intervals were calculated for questionnaire data. Focus groups were audio-recorded, transcribed verbatim, and coded for content analysis. Women most frequently preferred vaginal films to be smooth and thin (63 %), translucent (48 %), and 2″ × 2″ square size (36 %). Driving these preferences were five major themes: ease and accuracy of use, desire for efficacy, discretion, intravaginal comfort and minimal impact, and minimizing disruption of sexual mood/activities. Women’s preferences for various microbicide vaginal film physical attributes represented a balance of multiple values. In general, women desired a comfortable, efficacious, easy to use, and minimally intrusive product.
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Abdool Karim, Q., Abdool Karim, S. S., Frohlich, J. A., Grobler, A. C., Baxter, C., Mansoor, L. E., … Gengiah, T. N. (2010). Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science, 329, 1168–1174. doi:10.1126/science.1193748.
Baeten, J. M., Palanee-Phillips, T., Brown, E. R., Schwartz, K., Soto-Torres, L. E., Govender, V., … Siva, S. (2016). Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. New England Journal of Medicine. doi:10.1056/NEJMoa1506110.
Bunge, K. E., Dezzutti, C. S., Rohan, L. C., Hendrix, C. W., Marzinke, M. A., Richardson-Harman, N., … Hillier, S. L. (2016). A Phase 1 trial to assess the safety, acceptability, pharmacokinetics and pharmacodynamics of a novel dapivirine vaginal film. Journal of Acquired Immune Deficiency Syndromes, 71, 498–505. doi:10.1097/QAI.0000000000000897.
CDC. (2016, February 4). HIV among African Americans. Retrieved from http://www.cdc.gov/hiv/group/racialethnic/africanamericans/.
Coggins, C., Elias, C. J., Atisook, R., Bassett, M. T., Ettiegnene-Traore, V., Ghys, P. D., … VanDevanter, N. L. (1998). Women’s preferences regarding the formulation of over-the-counter vaginal spermicides. AIDS, 12, 1389–1391.
Crabtree, B. F., & Miller, W. L. (1999). Doing qualitative research (2nd ed.). Thousand Oaks, CA: Sage Publications.
Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). Thousand Oaks, CA: Sage Publications.
Daveson, B., O’Callaghan, C., & Grocke, D. (2008). Indigenous music therapy theory building through grounded theory research: the developing indigenous theory framework. Arts in Psychotherapy, 35, 280–286. doi:10.1016/j.aip.2008.06.005.
Giacomini, M. K., Cook, D. J., & Evidence-Based Medicine Working Group. (2000a). Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Journal of the American Medical Association, 284, 357–362.
Giacomini, M. K., Cook, D. J., & Evidence-Based Medicine Working Group. (2000b). Users’ guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Journal of the American Medical Association, 284, 478–482.
Glaser, B. G. (2002). Conceptualization: On theory and theorizing using grounded theory. International Journal of Qualitative Methods, 1, 23–38.
Green, G., Pool, R., Harrison, S., Hart, G. J., Wilkinson, J., Nyanzi, S., & Whitworth, J. A. (2001). Female control of sexuality: illusion or reality? Use of vaginal products in south west Uganda. Social Science and Medicine, 52, 585–598.
Hardy, E., Jimenez, A. L., de Padua, K. S., & Zaneveld, L. J. (1998). Women’s preferences for vaginal antimicrobial contraceptives. III. Choice of a formulation, applicator, and packaging. Contraception, 58, 245–249.
Higgins, J. A., Hoffman, S., & Dworkin, S. L. (2010). Rethinking gender, heterosexual men, and women’s vulnerability to HIV/AIDS. American Journal of Public Health, 100, 435–445. doi:10.2105/AJPH.2009.159723.
Marrazzo, J. M., Ramjee, G., Richardson, B. A., Gomez, K., Mgodi, N., Nair, G., … Hendrix, C. W. (2015). Tenofovir-based preexposure prophylaxis for HIV infection among African women. New England Journal of Medicine, 372, 509–518. doi:10.1056/NEJMoa1402269.
Mason, T. H., Foster, S. E., Finlinson, H. A., Morrow, K. M., Rosen, R., Vining, S., … Seage, G. R. (2003). Perspectives related to the potential use of vaginal microbicides among drug-involved women: Focus groups in three cities in the United States and Puerto Rico. AIDS and Behavior, 7, 339–351.
Mauck, C. K., Baker, J. M., Barr, S. P., Abercrombie, T. J., & Archer, D. F. (1997). A phase I comparative study of contraceptive vaginal films containing benzalkonium chloride and nonoxynol-9. Postcoital testing and colposcopy. Contraception, 56, 89–96.
Mays, N., & Pope, C. (2000). Qualitative research in health care. Assessing quality in qualitative research. British Medical Journal, 320, 50–52.
Nel, A. M., Mitchnick, L. B., Risha, P., Muungo, L. T., & Norick, P. M. (2011). Acceptability of vaginal film, soft-gel capsule, and tablet as potential microbicide delivery methods among African women. Journal of Women’s Health, 20, 1207–1214. doi:10.1089/jwh.2010.2476.
Patton, M. Q. (1999). Enhancing the quality and credibility of qualitative analysis. Health Services Research, 34, 1189–1208.
Patton, M. Q. (2015). Qualitative research and evaluation methods (4th ed.). Thousand Oaks, CA: Sage Publications.
Pool, R., Whitworth, J. A., Green, G., Mbonye, A. K., Harrison, S., Wilkinson, J., & Hart, G. J. (2000). An acceptability study of female-controlled methods of protection against HIV and STDs in south-western Uganda. International Journal of STD and AIDS, 11, 162–167.
Prejean, J., Song, R., An, Q., & Hall, H. (2008). Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. Morbidity and Mortality Weekly Report, 57, 985–989.
Raymond, E., Alvarado, G., Ledesma, L., Diaz, S., Bassol, S., Morales, E., … Carlos, G. (1999). Acceptability of two spermicides in five countries. Contraception, 60, 45–50.
Raymond, E. G., Chen, P. L., Condon, S., Luoto, J., Barnhart, K. T., Creinin, M. D., … Blackwell, R. (2005). Acceptability of five nonoxynol-9 spermicides. Contraception, 71, 438–442. doi:10.1016/j.contraception.2004.12.023.
Rustomjee, R., Abdool Karim, Q., Abdool Karim, S. S., Laga, M., & Stein, Z. (1999). Phase 1 trial of nonoxynol-9 film among sex workers in South Africa. AIDS, 13, 1511–1515.
Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23, 334–340.
Steiner, M., Spruyt, A., Joanis, C., Glover, L., Cordero, M., Alvarado, G., & Onoka, C. (1995). Acceptability of spermicidal film and foaming tablets among women in 3 countries. International Family Planning Perspectives, 21, 104–107.
Strauss, A. L., & Corbin, J. M. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications.
UNAIDS. (2011). Global HIV/AIDS response. Retrieved from http://www.who.int/hiv/pub/progress_report2011/hiv_full_report_2011.pdf.
Visness, C. M., Ulin, P., Pfannenschmidt, S., & Zekeng, L. (1998). Views of Cameroonian sex workers on a woman-controlled method of contraception and disease protection. International Journal of STD and AIDS, 9, 695–699.
Acknowledgments
This study was funded by a grant from the Doris Duke Charitable Foundation to the University of Pittsburgh School of Medicine to support Clinical Research Fellow Maria Fan and by Grant Number NIH U19AI082639. The authors wish to thank the study participants, the International Partnership for Microbicides for supplying placebo vaginal rings, and the many researchers who contributed their assistance and advice.
Funding
This study was funded by a grant from the Doris Duke Charitable Foundation to the University of Pittsburgh School of Medicine to support Clinical Research Fellow Maria Fan and by Grant Number NIH U19AI082639.
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None of the authors has a real or perceived conflict of interest in any of the material that is presented in the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Fan, M.D., Kramzer, L.F., Hillier, S.L. et al. Preferred Physical Characteristics of Vaginal Film Microbicides for HIV Prevention in Pittsburgh Women. Arch Sex Behav 46, 1111–1119 (2017). https://doi.org/10.1007/s10508-016-0816-1
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DOI: https://doi.org/10.1007/s10508-016-0816-1