Safety and Acceptability of Vaginal Rings That Protect Women From Unintended Pregnancy
Condition: Contraception
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      The study is a multidisciplinary research project and has two main aims:

        1. To determine the safety of a contraceptive vaginal ring (CVR) in women, with an emphasis
           on its effect on the vaginal microenvironment after different durations of use: the
           vaginal microbiome, biofilm formation on epithelial cells and rings, inflammation and
           immune activation in the vagina

        2. To investigate the feasibility, acceptability and adherence to vaginal ring use in
           Rwandan women, including attitudes towards a future multi-purpose vaginal ring for
           prevention of both pregnancy and sexually transmitted infections (STI).
    

Detailed description: 
      1. An integrated study design

           This clinical study combines a clinical safety evaluation of the contraceptive vaginal
           ring (CVR) with social science research on acceptability and adherence of ring use in
           Rwandan women.

           The clinical part of the study assesses the general safety of the contraceptive ring
           including the effect on the vaginal microbiome, genitourinary symptoms and signs and
           clinical adverse events. In addition the clinical part of the study aims to understand
           better the possible biofilm formation and to explore the impact of the ring on the
           microbiome and inflammation in the vagina.

           The social science component consists of a combination of a mixed-methods research
           including In-depth Interviews (IDIs), Focus Group Discussions (FGDs), questionnaires,
           and (if funding permits) audio computer-assisted self-interviewing (ACASI).

        2. Clinical study design

      This is an open label single-centre cohort study with the NuvaRing®. A total of 120 Human
      Immunodeficiency Virus(HIV)-negative women will be randomized to an intermittent regimen or a
      continuous regimen of ring use and will be followed for maximum 14 weeks, to determine
      general safety of the ring in the African context, and to determine differences in the
      vaginal microbiome and vaginal inflammation before and after use of a contraceptive vaginal
      ring (CVR). Qualitative research for the social science component will be performed to
      address the acceptability and adherence of intermittent or continuous CVR use in more depth.

      Women will be randomized into two study groups: 60 intermittent users in group A and 60
      continuous users in group B. Both groups will use the NuvaRing®. Women in group A (the
      intermittent users) will use each CVR for 3 weeks followed by one week of no ring use to
      allow menstruation. Women in group B (the continuous users) will use each ring for 3 weeks,
      with the next ring being inserted immediately after the previous one and no off period in
      between [4]. The total duration from enrolment to the last study visit is maximum 14 weeks.
      The screening process will be a maximum of 6 weeks.

      As noticed above, the study will include also a social sciences component, aimed at assessing
      the level of acceptability and reported adherence to intermittent and continuous
      Contraceptive Vaginal Rings (CVRs) use in women in Rwanda; at identifying and describe the
      context specific attitudes and beliefs regarding family, family planning, and gendered norms;
      at exploring the women's beliefs and expectations regarding future potential use of a
      multi-purpose ring (contraception and Human Immunodeficiency Virus (HIV) prevention); and at
      exploring how women and men in Rwanda perceive and experience risk related to unwanted
      pregnancy and Human Immunodeficiency Virus (HIV). This part of the study will result in
      qualitative outcomes.
    

Intervention name(s): Vaginal Ring - intermittent regimen; Vaginal Ring - continuous regimen
Intervention type(s): Device; Device
Intervention description(s): NuvaRing® used intermittently. Nuvaring is a contraceptive vaginal ring, manufactured by N.V. Organon (a subsidiary of Merck & Co., Inc.,), Oss, the Netherlands. It contains 11.7 mg etonogestrel and 2.7 mg ethinylestradiol. It releases etonogestrel and ethinylestradiol at an average amount of 0.120 mg and 0.015 mg, respectively per 24 hours, over a period of 3 weeks. It is approved since 2001 by most countries within the European Union, and in the United Stated by the FDA.; NuvaRing® used continuously. Nuvaring is a contraceptive vaginal ring, manufactured by N.V. Organon (a subsidiary of Merck & Co., Inc.,), Oss, the Netherlands. It contains 11.7 mg etonogestrel and 2.7 mg ethinylestradiol. It releases etonogestrel and ethinylestradiol at an average amount of 0.120 mg and 0.015 mg, respectively per 24 hours, over a period of 3 weeks. It is approved since 2001 by most countries within the European Union, and in the United Stated by the FDA.
Other intervention name(s): NuvaRing®: etonogestrel/ethinylestradiol; NuvaRing®: etonogestrel/ethinylestradiol
Intervention MeSH terms: Ethinyl Estradiol; Desogestrel; Etonogestrel; NuvaRing
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research