In the first phase of MTN-032, up to 224 ASPIRE participants with varying levels of adherence to the dapivirine vaginal ring will be enrolled. Based upon participants’ ASPIRE plasma dapivirine levels and residual drug levels from returned vaginal rings, participants will be pre-selected and approached for study participation. Enrolled participants will be categorized into one of the following groups (with final group designation dependent on adequate sample size):
· Consistently low adherence
· Inconsistent adherence
· Consistently high adherence
After being presented their ASPIRE ring adherence results (PK and residual drug level results), participants will be asked to complete a single in-depth interview (IDI) or a focus group discussion (e.g., with other participants with similar adherence levels) where factors influencing adherence, as well as strategies used to overcome adherence challenges, will be explored. Intermittent and strategic use around study visits will also be discussed.
The second phase of MTN-032 will examine the effect of known efficacy level on adherence in participants who take part in HOPE, an open label extension trial to ASPIRE. A single IDI will be conducted during the second phase of this study to explore:
· Motivations for participant enrollment into HOPE among participants with varying levels of adherence in ASPIRE
· What effect, if any, knowledge of the ring’s efficacy had on adherence behavior
· Motivation for continued study participation among those participants who were inconsistently or not adherent
· VR uptake, marketing and other product roll-out issues
It is anticipated that each phase of this study will take approximately 4-6 months to enroll the target sample size.