Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis.

摘要: The vaginal ring (VR) is a female-initiated drug-delivery platform used for different indications, including HIV pre-exposure prophylaxis (PrEP). We conducted systematic review of VR acceptability, values and preferences among women in low- middle-income countries (LMIC) to inform further investment and/or guidance on use prevention. Following PRISMA guidelines, we structured methods search, screen, extract data from randomized controlled trials (RCTs) observational studies reporting quantitative outcomes acceptability the any indication published 1/1970-2/2019 (PROSPERO: CRD42019122220). Of 1,110 records identified, 68 met inclusion criteria. Studies included 15-50+ years 25 LMIC indications prevention, contraception, abnormal bleeding, menopause. Overall was high (71-98% across RCTs; 62-100% studies), with 80-100% continuation rates RCTs favorable ease insertion (greater than 85%) removal 89-99%). Users reported concerns about getting lost body (8-43%), although actual expulsions adverse events were generally infrequent. Most disclosed partners, some worrying partner anger/violence. not felt during intercourse by 70-92% users 48-97% partners. Acceptability improved over time both within (as gained experience worries diminished), chronological device popularized). Women expressed accessible, long-acting, partner-approved that prevent pregnancy, can be without knowledge, have no impact sex few side effects. This limited lack standardization measures study heterogeneity. suggests most positive view increases familiarity use; and, many would consider an acceptable future delivery prevention or other indications.