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Using Emoji Stickers to Understand End-User Opinions of the Dapivirine Vaginal Ring for HIV Prevention

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Abstract

Globally, HIV affects women disproportionally to men, particularly in sub-Saharan Africa. While the monthly dapivirine vaginal ring (VR) is a promising female-initiated HIV prevention method, it is important to understand how well the ring is liked. With former participants of HOPE, an open-label extension trial of the ring, we used emoji stickers and a worksheet to explore female end-user’s acceptability of and opinions about the VR. We aimed to understand these participants’ opinions about the VR, and how they had changed over time, particularly in the context of known efficacy of the dapivirine VR. Most participants easily understood the exercise and how to use the emoji stickers, with a few exceptions. For those who had trouble understanding how to use the emoji, interviewer support and encouragement helped them to understand and continue with the exercise. Emoji interpretation varied widely with participants using the same emoji to express divergent opinions. Using the emoji stickers, participants expressed mostly positive opinions of the vaginal ring for HIV prevention, with some lingering concerns about the product’s partial effectiveness. This paper contributes to the literature supporting the assertion that the dapivirine VR for HIV prevention is acceptable to women, and that acceptability increases with time and proper education. This analysis also provides evidence that emoji visual tools can enhance understanding of acceptability of an intervention when used in qualitative research.

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Data Availability

We did not receive consent from participants to make the study data available and thus the data will not be available to the public. If someone is interested in exploring the data they should contact the lead author.

References

  1. UNAIDS. Women and HIV — A spotlight on adolescent girls and young women [Internet]. Unaids.org. 2019 [cited 2020 Mar 4]. https://www.unaids.org/en/resources/documents/2019/women-and-hiv.

  2. International Partnership for Microbicides (IPM). IPM’s application for dapivirine vaginal ring for reducing HIV risk in women now under review by European medicines agency [Internet]. Ipmglobal.org. 2017 [cited 2020 Mar 4]. https://www.ipmglobal.org/content/ipm%E2%80%99s-application-dapivirine-vaginal-ring-reducing-hiv-risk-women-now-under-review-european.

  3. Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–32.

    Article  CAS  Google Scholar 

  4. Nel A, Bekker L-G, Bukusi E, et al. Safety, acceptability and adherence of dapivirine vaginal ring in a microbicide clinical trial conducted in multiple countries in Sub-Saharan Africa. PLoS ONE. 2016;11(3):e0147743.

    Article  Google Scholar 

  5. Brown ER, Hendrix CW, van der Straten A, et al. Greater dapivirine release from the dapivirine vaginal ring is correlated with lower risk of HIV-1 acquisition: a secondary analysis from a randomized, placebo-controlled trial. J Int AIDS Soc. 2020;23(11):e25634.

    Article  CAS  Google Scholar 

  6. International Partnership for Microbicides (IPM). In milestone for women’s HIV prevention, European Medicines Agency adopts positive opinion on monthly vaginal ring to reduce HIV risk [Internet]. Ipmglobal.org. 2020 [cited 2020 Nov 28]. https://www.ipmglobal.org/content/milestone-women%E2%80%99s-hiv-prevention-european-medicines-agency-adopts-positive-opinion-monthly.

  7. World Health Organization (WHO). WHO recommends the dapivirine vaginal ring as a new choice for HIV prevention for women at substantial risk of HIV infection [Internet]. Who.int. 2021 [cited 2021 May 31]. https://www.who.int/news/item/26-01-2021-who-recommends-the-dapivirine-vaginal-ring-as-a-new-choice-for-hiv-prevention-for-women-at-substantial-risk-of-hiv-infection.

  8. van der Straten A, Montgomery ET, Cheng H, Wegner L, Masenga G, von Mollendorf C, et al. High acceptability of a vaginal ring intended as a microbicide delivery method for HIV prevention in African women. AIDS Behav. 2012;16(7):1775–86.

    Article  Google Scholar 

  9. Celum CL, Delany-Moretlwe S, Baeten JM, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(Suppl 4):e25298.

    PubMed  PubMed Central  Google Scholar 

  10. Marrazzo JM, Ramjee G, Richardson BA, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–18.

    Article  Google Scholar 

  11. Montgomery ET, van der Straten A, Chitukuta M, et al. Acceptability and use of a dapivirine vaginal ring in a phase III trial. AIDS. 2017;31(8):1159–67.

    Article  CAS  Google Scholar 

  12. Gilliam ML, Neustadt A, Kozloski M, Mistretta S, Tilmon S, Godfrey E. Adherence and acceptability of the contraceptive ring compared with the pill among students: a randomized controlled trial. Obstet Gynecol. 2010;115(3):503–10.

    Article  Google Scholar 

  13. Kerns J, Darney P. Vaginal ring contraception. Contraception. 2011;83(2):107–15.

    Article  CAS  Google Scholar 

  14. Terrell LR, Tanner AE, Hensel DJ, Blythe MJ, Fortenberry JD. Acceptability of the vaginal contraceptive ring among adolescent women. J Pediatr Adolesc Gynecol. 2011;24(4):204–10.

    Article  Google Scholar 

  15. Baeten J, Palanee-Phillips T, Mgodi N, Mayo A, Nel A, Rosenberg Z, et al. High uptake and reduced HIV-1 incidence in an open-label trial of the dapivirine ring. Presented at: 25th Conference on Retroviruses and Opportunistic Infections (CROI) 2018; Boston, MA; Croiconference.org. 2018. https://www.croiconference.org/abstract/high-uptake-and-reduced-hiv-1-incidence-open-label-trial-dapivirine-ring/.

  16. Nel A, Van Niekerk N, Van Baelen B, Rosenberg Z. HIV incidence and adherence in DREAM: an open-label trial of Dapivirine ring. Presented at: 25th Conference on Retroviruses and Opportunistic Infections (CROI) 2018; Boston, MA; Croiconference.org. 2018. https://www.croiconference.org/abstract/hiv-incidence-and-adherence-dream-open-label-trial-dapivirine-vaginal-ring/.

  17. Griffin JB, Ridgeway K, Montgomery E, et al. Vaginal ring acceptability and related preferences among women in low- and middle-income countries: a systematic review and narrative synthesis. PLoS ONE. 2019;14(11):e0224898.

    Article  CAS  Google Scholar 

  18. Bai Q, Dan Q, Mu Z, Yang M. A systematic review of emoji: current research and future perspectives. Front Psychol. 2019;10:2221–2221.

    Article  Google Scholar 

  19. Baeten JM, Palanee-Phillips T, Mgodi NM, et al. Safety, uptake, and use of a dapivirine vaginal ring for HIV-1 prevention in African women (HOPE): an open-label, extension study. Lancet HIV. 2021;8(2):e87–95.

    Article  Google Scholar 

  20. Naidoo K, Mansoor LE, Katz AWK, et al. Qualitative Perceptions of dapivirine VR adherence and drug level feedback following an open-label extension trial. JAIDS J Acquir Immune Defic Syndr. 2021;86(4):e90–6.

    Article  Google Scholar 

  21. American Psychological Association (APA). Mood Congruent Memory [Internet]. Apa.org. [cited 2020 Apr 30]. https://dictionary.apa.org/mood-congruent-memory.

  22. Young I, McDaid L. how acceptable are antiretrovirals for the prevention of sexually transmitted HIV?: a review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav. 2014;18(2):195–216.

    Article  Google Scholar 

  23. Baeten JM, Haberer JE, Liu AY, Sista N. Preexposure prophylaxis for HIV prevention: where have we been and where are we going? JAIDS J Acquir Immune Defic Syndr. 2013;63:S122–9.

    Article  Google Scholar 

  24. Van der Straten A, Katz A, Balán I, et al. A qualitative evaluation of women's experience receiving drug feedback in MTN-025/HOPE - an HIV prevention open-label trial of the dapivirine vaginal ring. Poster presented at: 22nd International AIDS Conference 2018; Amsterdam, the Netherlands.

  25. van der Straten A, Montgomery ET, Musara P, et al. Disclosure of pharmacokinetic drug results to understand nonadherence. AIDS. 2015;29(16):2161–71.

    Article  Google Scholar 

  26. Baxi SM, Liu A, Bacchetti P, et al. Comparing the novel method of assessing PrEP adherence/exposure using hair samples to other pharmacologic and traditional measures. JAIDS J Acquir Immune Defic Syndr. 2015;68(1):13–20.

    Article  CAS  Google Scholar 

  27. Gesselman AN, Ta VP, Garcia JR. Worth a thousand interpersonal words: emoji as affective signals for relationship-oriented digital communication. PLoS ONE. 2019;14(8):e0221297.

    Article  CAS  Google Scholar 

  28. Lotfinejad N, Assadi R, Aelami MH, Pittet D. Emojis in public health and how they might be used for hand hygiene and infection prevention and control. Antimicrob Resist Infect Control. 2020;9(1):27.

    Article  Google Scholar 

  29. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88.

    Article  Google Scholar 

  30. Glegg SMN. Facilitating interviews in qualitative research with visual tools: a typology. Qual Health Res. 2019;29(2):301–10.

    Article  Google Scholar 

  31. Lu X, Ai W, Liu X, Li Q, Wang N, Huang G, et al. Learning from the ubiquitous language: An empirical analysis of emoji usage of smartphone users. In: Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing - UbiComp ’16. New York, New York, USA: ACM Press; 2016.

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Acknowledgements

We would like to thank MTN-032 participants for their contribution to this research. The Microbicide Trials Network (MTN) leadership and operating center, FHI 360, and MTN-032 Protocol study team members are acknowledged as critical in the development, implementation, and/or analysis of this study. The full MTN-032 study team can be viewed at https://mtnstopshiv.org/research/studies/mtn-032.

Funding

The study was designed and implemented by the Microbicide Trials Network (MTN) funded by the National Institute of Allergy and Infectious Diseases through individual grants (UM1AI068633, UM1AI068615 and UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The vaginal rings used in this study were supplied by the International Partnership for Microbicides (IPM).

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Authors

Contributions

AWKK was involved in the study design, oversaw study implementation, data coding and analysis, data interpretation, and writing this article. LEM, MT, FM, DS, SS, CA, and THC were involved with study implementation at the study site, data collection, and article review. MG and LST were involved with overall study implementation and article review. ETM was involved in the study design, overall study implementation, data interpretation, and critical revision of this article.

Corresponding author

Correspondence to Ariana W. K. Katz.

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The authors have no conflicts of interest to disclose.

Ethical Approval

The study was approved by the Institutional Review Boards at RTI International, all study sites, and was overseen by the regulatory infrastructure of the US National Institutes of Health and the Microbicide Trials Network.

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All study participants provided written informed consent to participate in the study through a consent process approved by local ethical review committees in all research settings.

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All participants were informed that any publication of this study will not use their name or identify them personally.

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Katz, A.W.K., Mansoor, L.E., Tsidya, M. et al. Using Emoji Stickers to Understand End-User Opinions of the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav 25, 3955–3966 (2021). https://doi.org/10.1007/s10461-021-03338-1

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