Background
Women worldwide need and want multipurpose prevention technologies (MPTs) to meet their varied sexual-reproductive health needs. Most MPTs in development are vaginal rings. We assessed US women’s preferences re: specific ring attributes, to optimize a nonhormonal MPT ring in development to prevent pregnancy, HIV, other sexually transmitted infections (STIs), and bacterial vaginosis (BV).
Methods
We conducted a cross-sectional online survey with sexually active US women ages 18-49 years currently/interested in using contraception, recruited via Prime Panels. The survey included a discrete choice experiment (DCE) comprising 7 attributes with varying levels, identified via qualitative research. We analyzed data using mixed multinomial logit models.
Results
2,105 women were surveyed Dec 2023-Jan 2024 (mean age 31 years) in all 50 states. 53% were married/cohabiting; 57% had ≥1 child; 43% ever had an unintended pregnancy; 9% were diagnosed with an STI in the last year; 49% ever had BV. Women strongly preferred an MPT ring with higher effectiveness to prevent pregnancy (Coefficient: 0.020), HIV (0.011), and STIs (0.006) (all p<0.001; stronger among women ages 18-29). BV prevention was also preferred (p<0.001). A nonhormonal ring was important to the 61% of women averse to hormonal contraception (including due to previous side effects), and an on-demand use option (vs. must use continuously) was important to the 26% with multiple sexual partners. There was a negative preference for a ring causing heavier/unpredictable periods (vs. no effect) (p<0.001). Women were willing to make tradeoffs in effectiveness for each indication, for other desired attributes, e.g., for a 10% increase in HIV and STI prevention effectiveness, they would give up 6% and 3% in pregnancy prevention effectiveness, respectively (both p<0.001). After the DCE, when asked to consider a nonhormonal MPT ring at moderate levels of protection (80% for pregnancy, 50% for HIV/STIs), 74% of women were interested/very interested in using it (69% within one year).
Conclusions
US women reported strong interest in an MPT ring. When evaluating MPT ring attributes, effectiveness for pregnancy and HIV prevention– the focus of most MPT research– were most important, but STI and BV prevention were also valued. Preferences were heterogeneous, and nonhormonal and on-demand options were only preferred among subsets of women. Continued end-user research regarding varied preferences and tradeoffs is needed to optimize future MPT products.