Background: Modest protection against HIV infection for women over age 25 in sub-Saharan Africa has been reported in recent Phase III trials of a vaginal ring (VR) continuously releasing the antiretroviral drug dapivirine. No protection was found for women under 21 years likely due to poorer adherence. Better understanding of VR acceptability and adherence is needed for younger women.
Methods: Ninety-six 15-17 year old adolescents from four U.S. cities were enrolled in a Phase 2a placebo-controlled safety trial of the dapivirine VR. Of these, 21 were randomly selected for in-depth semi-structured interviews (IDI) at their final clinic visit. Participants used the VR for either 12 or 24 weeks. Trained interviewers conducted visual web-interviews. Open-ended questions covered participant overall experiences and feelings using the VR, and her reports of partner attitudes and experiences with the ring, including during sexual intercourse. Interviews were digitally recorded, transcribed verbatim, entered into Atlas TI, and analyzed using thematic content analysis.
Results: The 21 IDIs were conducted with 5 and 16 adolescents on study for 12 and 24 weeks, respectively. Most participants reported initial concern with the size of the ring but few reported discomfort or concerns after insertion. Few removed the ring or experienced expulsion, but when removal occurred, reasons were hygiene (to clean it) or curiosity (to check or show partner). Many reported the partner could feel the ring during sexual activity. Concerns raised about using the ring included hygiene, discharge ascribed to the VR, and discomfort about sex because partner could feel it. Nevertheless, most reported not feeling the ring much while in situ nor paying attention to it.
Conclusions: Our findings indicate there may be high acceptability of VR as a HIV prevention method for US adolescent females. Principal concerns for young women are partners'' feeling the ring during sex and hygiene issues - issues that may be managed proactively by clinic staff to help increase acceptability and adherence.

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