Table 3. Studies reporting vaginal ring overall acceptability and/or continuation outcomes, endline assessment.
| First author, year (Trial name) |
n (ring users) (Country) | Indication | Ring attributes | Satisfy (%) | Recommend (%) | Acceptable (%) |
Like (%) |
Continuation by month/cycle (%) |
Risk of biasa |
|---|---|---|---|---|---|---|---|---|---|
| Randomized Controlled Trials | |||||||||
| Hardy; 2007 [79] | 405 (Brazil) | HIV prevention | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | - | - | - | 52.9 | - | H |
| Nel; 2016 [64] | 280 (Kenya, Malawi, South Africa, Tanzania) | HIV prevention | Dapivirine, platinum-catalyzed silicone, 56x7.7mm | - | - | 96 | - | - | U |
|
Kestelyn, Kestelyn; 2018, 2018 [51, 52] |
120 (Rwanda) | Contraception | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | - | 98.3b | - | - | L | |
| Mohamed; 2011 [59] | 300 (Egypt) | Contraception | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | - | - | - | - | 3 mo: 87.7 6 mo: 82.7 9 mo: 81.3 12 mo: 79.9 |
H |
| Sharma; 2018 [39] | 225 (India) | Contraception | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | 95.3 | - | - | - | - | U |
| Hashim; 2012 [44] | 48 (Egypt) | Abnormal uterine bleeding | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | 70.8 | - | - | - | 3 cycle: 100 | L |
| Jain; 2016 [32] | 30 (India) | Abnormal uterine bleeding | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | 96.7 | 90 | - | - | 90 | L |
|
Minnis, Weinrib, van der Straten; 2018, 2018, 2018 [58, 72, 75] (TRIO) |
277 (South Africa, Kenya) | MPT | Placebo, silicone elastomer (dimensions NR) | - | - | - | 65.6c | - | L |
|
Thurman; 2018 [83] (CONRAD A13-128) |
27 (Dominican Republic) | MPT | G1: TDF G2: TDF+LNG G3: Placebo Hydrophilic polyurethane, 55x5.5mm |
- | - | - | - | G1: 90.9% G2: 100% G3: 100% |
l |
| Observational Studies | |||||||||
|
Barreiros, Guazzelli; 2007, 2009 [76, 78] |
75 (Brazil) | Contraception | NR | - | - | - | - | 82.7 | L |
| Buckshee; 1990 [26] | 96 (India) | Contraceptive | LNG, Silastic, 55.6x9.5 mm | - | - | - | - | 52 wks: 44.5 | H |
| Chen; 1998 [27] | 197 (China) | Contraception | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | - | - | - | - | 34.6 | U |
| Das; 2016 [29] | 50 (India) | Contraception | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | 95 | 96 | 92 | - | 88 | H |
| Faundes, Hardy; 1981, 1983 [77, 80] | 355 (Brazil and Dominican Republic) | Contraception | LNG + estradiol, Silicone elastomer, 58 mm | - | 62.1 | - | - | - | U |
| Gupta; 1986 [31] | 70 (India) | Contraception | Progesterone, Silicone elastomer, 55.6x9.5 mm | - | - | - | - | 3 mo: 55.7 6 mo: 45.7 9 mo: 37.1 (calculated) |
H |
| Koetswang; 1990 [90] | 789 in LMIC (Tunisia, Zambia, Russia, India, Thailand, Pakistan, Brazil, Colombia, Cuba) | Contraception | LNG, Silicone elastomer, 55.6x9.5 mm |
- | - | - | - | Africa: 31.9 Asia: 40.1 China: 68.3 Latin America: 42.9 |
L |
| Mehta; 1981 [34] | 39 (India) | Contraception | EE + d-norgestrel, polysiloxane, 61x9.5 mm | - | - | - | - | 56.4 | H |
| Pandit; 2014 [36] | 252 (India) | Contraception | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | 94.2 | 93.2 | - | - | - | L |
|
RamaRao, RamaRao, Ishaku; 2015, 2015, 2018 [50, 69, 70] |
363 (Kenya, Nigeria, Senegal) | Contraception | Silicone elastomer, 58mm x 8.4mm, 10 mg progesterone daily, administered continuously up to 3 months | 96.8 | 97.9 | - | - | - | H |
| Santibenchakul; 2016 [38] | 39 (Thailand) | Contraception | EE, flexible, transparent, colorless, 54x4 mm (NuvaRing) | 71 | 100 | - | - | 6 cycle: 97.4 | U |
| Shaaban; 1991 [89] | 103 (Egypt) | Contraception | Progesterone, silicone elastomer, 58.4x8.8 mm | - | - | - | - | 66.59 | U |
| Sivin; 1981 [92] | 1,636 (Brazil, Dominican Republic, Nigeria) | Contraception | Progesterone, silicone elastomer, 58x8.4 mm | - | - | - | - | Salvador, Brazil: 48 Campinas, Brazil: 55 Dominican Republic: 36 Nigeria: 38 |
H |
| Soni; 2013 [42] | 184 (India) | Contraception | EE + ENG, ethinyl vinyl acetate, 54x4 mm | - | 97 | - | - | 3 mo: 94.6 12 mo: 86.4 |
H |
EE = ethinyl estradiol; TDF = Tenofovir; LNG = levonorgestrel; ENG = etonogestrel; mo = months; G = Group; MPT = multipurpose prevention technology; wks = weeks
a Risk of bias summary assessments. H = high; L = low; U = unclear
b At end of study
c Mean score of liking product (1–5 Likert scale, higher score indicates higher acceptability)– 3.28, converted to 100 point scale.