Using emoji stickers to understand opinions of the dapivirine vaginal ring for HIV prevention among female end-users and their male partners


BACKGROUND: The monthly dapivirine vaginal ring (VR) is a promising female-initiated prevention method that, with high adherence, has shown reduced risk of HIV acquisition in clinical trials. Understanding VR acceptability among experienced end-users and their male partners (MP) offers insight into factors that might impact its effective use at a population level.
METHODS: To explore VR acceptability, following the Microbicide Trials Network (MTN) HIV Open-label Prevention Extension (HOPE) trial, former HOPE participants and MP were recruited from 6 of 14 sites, representing all trial countries (Malawi, South Africa, Uganda, Zimbabwe). During in-depth interviews (IDI) or focus-group discussions (FGD), participants selected and placed emoji stickers on an 'opinion tool' to stimulate discussion of attitudes towards the VR over time. Emoji use was tabulated; qualitative data were transcribed, translated, and coded using Dedoose software.
RESULTS: Fifty-eight women and one MP had an IDI; 53 men participated in one of 11 FGDs. 12 of 22 possible emojis (55%) were selected by at least 10% of women or MP (Table 1). Although emoji interpretation varied widely, the activity facilitated detailed discussions about VR opinions. Both groups felt primarily positive about the VR because it provided HIV protection, was easy to use, lacked side effects, improved or did not change sex, and enabled involvement in HIV prevention (MP only). Common negative opinions were shock or fear due to a lack of understanding (MP only), suspected lack of HIV protection, and fear of or actual side effects. Many women reported consistently positive opinions throughout HOPE. Some women and men's opinions improved over time with increased familiarity and receipt of more information about the VR, or counselor and staff encouragement.

CONCLUSIONS: An emoji activity stimulated MP and women to provide multiple VR opinions, predominantly positive. Opinions pointed to educational messages that could enhance future understanding, acceptance and adjustment of ring use.