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Conclusions Feasibility and acceptability of cervical barriers among vulnerable youth: a pilot study in Zimbabwe Ariane van der Straten 1, Nuriye Sahin-Hodoglugil 1, Sibongile Mtetwa 2, Kate Clouse 1, Tarisai Chirenje 2, Violet Nyambo 2, Michael Chirenje 2 1 Women’s Global Health Imperative, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA USA 2 University of Zimbabwe–University of California, San Francisco, Collaborative Research Programme in Women’s Health, Harare, Zimbabwe Study Purpose To explore the feasibility and acceptability of 3 cervical barriers (CB) for HIV prevention among female youth (ages 16-21) in Harare region, Zimbabwe Study Design 7 focus group discussions (FGD) with 47 youths One individual follow-up visit (n=45) – Randomly assigned to one of the three CB – Assessed willingness to practice insertion – Explored device preference – For each CB, we assessed via in- depth interview: Experience with insertion and removal Likes and dislikes about assigned CB Potential future CB preference Participants’ Assessment of Inserting and Removing Their Assigned Device Study Purpose and Design Cervical barriers were popular among young women who tried them Most participants were comfortable with inserting and removing their assigned CB The majority preferred SILCS Evaluating these methods further in larger studies appears feasible Acknowledgements YCB study participants YCB staff at UZ-UCSF and UCSF AIDS Research Institute (ARI) Pilot Awards Program Program for Appropriate Technology in Health (PATH) “ What did you like and dislike about the device you tried?” Age 16 to 21 years (inclusive) Ever had vaginal sex Living in the greater Harare region, Zimbabwe Speak, read and write in Shona or English Willing and able to give informed consent Eligibility Criteria Study Products Ortho All-Flex diaphragm Latex rubber, dome-shaped device Approved for contraception Must be fitted; 9 sizes (55-95 mm) FemCap Silicone cervical cap Approved for contraception Comes in 3 sizes; sized according to obstetrical history SILCS diaphragm Silicone diaphragm Not approved for contraception yet One size only; no fitting Characteristics of Participants and CB Practice Results “Would you prefer to use a CB continuously or when you need it?” Young Women’s Attitudes About Using CB Socio-Demographic Characteristics of Female Youth (n=47) Age (mean) 19.0 (16-21) Married and living together (%)46.8 Total lifetime sexual partners (mean) 1.4 (1-10) Age at first sex (mean) 16.9 (13-20) Used condoms at last sex (%)35.6 Used contraception at last sex (%)62.2 CB Practice Results (n=45) SILCSOrthoFemCap (n=14)(n=15)(n=16) Inserted properly at first attempt (%)508081.3 Removed properly (%)100 93.8 Liked the device she tried (%)10093.387.5 SILCS (n=14) Ortho (n=15) FemCap (n=16) Total Insertion was :% (n) Easy78.6 (11)73.3 (11)68.8 (11)73.3 ( 3 3 ) Somewhat difficult21.4 (3)26.7 (4)31.3 (5)26.7 ( 1 2 ) Very difficult000 0 Removal was:% (n) Easy100.0 (14)86.7 (13)68.8 (11)84.4 ( 3 8 ) Somewhat difficult013.3 (2)31.3 (5)15.6 (7) Very difficult000 0 CB use preferenceNumber% Prefer to use CB continuously “Sometimes you forget your pill and the cervical barrier can help with that.” (19 yrs, married) “Because that way you are prepared all the time because when your husband wants to have sex it will be difficult to start thinking about putting it on and he might not like it.” (21 yrs, married) “Because sometimes you do not expect to have sex with someone, so that way you prevent many things.” (16 yrs, single) 2555.6 Prefer to use CB when she needs it “I think it will last longer because when you wear it continuously it can be affected by the heat.” (20 yrs, divorced) “I think that it will move from its position. [If] I use it continuously and when you do have sex it will not be in the right position.” (21 yrs, single) “Sometimes I might want to get pregnant and in those instances I will not want to use it. When I don't want to get pregnant then I will use it.” (20 yrs, married) “Because sometimes I might not want to use and I might want to use other things. Also I would also want to find out how my body will tolerate it before I can use it continuously.” (17 yrs, married) 2044.4 “Which device are you interested in trying in the future?” Device participant indicates that she is interested in trying in the future. Inserted Ortho % (n=15) Inserted SILCS % (n=14) Inserted FemCap % (n=16) Total % (n) Wants to try Ortho (n)33 (5)21 (3)6 (1)20 (9) Wants to try SILCS (n)60 (9)52 (8)56 (9)58 (26) Wants to try FemCap (n)7 (1)21 (3)36 (6)22 (10) Study Location LikedDisliked Ortho All- Flex “It went in and covered the cervix. It is strong and soft.” (20 yrs, divorced)“ It is easy to insert because you can just fold it and it goes in.” (17 yrs, single) “I did not like having to try different sizes. It's painful to try and remove different ones.” (20 yrs, separated) “I don't like the rim. It's too stiff.” (19 yrs, single) SILCS “I like everything about it, but mostly/particularly the hook because you just put your finger and it becomes easy to insert.” (21 yrs, divorced) “It is soft and it closes the mouth of the uterus. It looks big enough to close everything that I would not worry about infection. (21 yrs, married) “It's hardness/rigidness at the edges.” (16 yrs, single) “It is too long.” (18 yrs, single) FemCap “It was easy to use. I also liked the size and it closes the cervix nicely.” (21 yrs, married) “I like the hook. It makes it easy to remove it without slipping.” (21 yrs, married) “I didn't like it. It looks hard, rigid and I thought it would be painful to wear. In the end it was not hard.” (21 yrs, single) “I did not like the fact that when you are having sex your partner could feel the hook.” (17 yrs, married)