Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015

Details

• Alternative Title:
  J Glob Health Rep
• Personal Author:
  McLellan-Lemal, Eleanor ; Gvetadze, Roman ; Desai, Mitesh A. ; Makanga, Esther M. ; Pan, Yi ; Haaland, Richard E. ; Holder, Angela N. ; Mudhune, Victor ; Williams, Tiffany ; Samandari, Taraz
• Description:
  Background
  
  Given future potential use of vaginal rings to prevent HIV infection, we examined the association of contraceptive vaginal ring (CVR) non-adherence with user dissatisfaction, tolerability, demographic, and behavioral factors.
  
  Methods
  
  In an open-label single-group study, sexually active women aged 18–34 years using oral or injectable hormonal contraception, conveniently sampled from general population, were assigned to 6-month use of a commercial CVR currently not licensed for use in Kenya. Non-adherence in any CVR cycle completed was assessed from: (1) self-report (not used for at least 1 day), and (2) pharmacy record (failure to timely receive a new CVR or return a used one). Additionally, non-adherence was assessed in a subset of participants by residual progestin and estrogen levels measured in returned CVRs.
  
  Results
  
  Of 202 participants who underwent CVR insertion by a study clinician, 142 completed all 6 visits, 172 responded to questions about ring use, and 43 provided used CVRs from months 1, 3, and 6 for residual hormone analysis. Non-adherence was 14.0% (24/172) by self-report and 54.5% (110/202) by pharmacy record. Non-adherence by pharmacy record was significantly reduced among women with a salary-based income (prevalence ratio (PR) 0.71, 95% confidence interval (CI) (0.55–0.91)] compared to women with income not salary-based or no income. Participants dissatisfied with CVR on ≥4 aspects (ambiguity of instructions, inconvenience of use, sensation, sexual discomfort, etc.) were more likely to report non-adherence (PR 2.69, 95% CI=(1.31–5.52)] compared to those dissatisfied with ≤3 aspects. Non-adherence by residual hormone levels was identified in 46.5% (20/43) participants. Over time, this subset of participants showed increasing non-adherence (P=0.004). We found lack of agreement among the various measures of non-adherence.
  
  Conclusions
  
  Economic empowerment interventions, especially those emphasizing partner-independent income options, and expanded education on CVR features may alleviate non-adherence. Addressing CVR dissatisfaction preemptively may also help mitigate non-adherence.
  
  
• Keywords:
  Chlorination Household Water Treatment Safe Water Storage
• Source:
  J Glob Health Rep. 2
• Pubmed ID:
  30976663
• Pubmed Central ID:
  PMC6454569
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Place as Subject:
  Kenya
• Volume:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:90131bdedc6e0529b8be8988d06d077d0ad46501908394299d8075d1c100d44723e2ea05f71ed151e9e061abcc67ca5268898899c7fb7b9713f386ef26cff312
• Download URL:
  https://stacks.cdc.gov/view/cdc/77585/cdc_77585_DS1.pdf
• File Type:
  [PDF - 537.63 KB ]