Acceptability of Vaginal Probiotics Use To Prevent Bacterial Vaginosis Recurrence In High-Risk Rwandan Women
Verwijs MC1, Agaba SK2, Uwineza M2, Umulisa MM2, van de Wijgert JHHM2,3
1Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; 2Rinda Ubuzima, Kigali, Rwanda. 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Aim: Bacterial vaginosis (BV) in Rwandan women at risk of HIV and sexually transmitted infections is common. We conducted a pilot study to determine the feasibility, acceptability, and preliminary efficacy of three interventions to prevent BV recurrence.
Methods: 68 women who completed oral metronidazole treatment for BV and/or Trichomonas vaginalis were randomised to four groups (N=17 each): no product, or intermittent use of oral metronidazole, or one of two vaginal probiotics. Participants inserted the first dose under direct observation and used products for two months. They were counselled to practice safer sex, cease vaginal practices, and encourage male partner penile hygiene. Data were collected in face-to-face and in-depth interviews, daily diaries, and focus group discussions.
Results: Most women (93%) were sex workers and the BV prevalence (by Nugent) at baseline was 83.6%. None had ever heard of or used probiotics. Women were able to insert correctly without practice (100%), inserted before going to sleep (100%), while lying down (94%), and reported that inserting became easier over time (100%). Most women (90%) reported to have used >80% of the required doses (Fisher's exact p=0.371 between groups), and 60% of women had perfect adherence. Most frequently reported reasons of non-adherence were 'simply forgetting' (n=11), being away from home and forgetting the product (n=2), side-effects (n=2), and having menses (n=2). Qualitative data suggested that women believed the products were helpful, but that male partners were not always supportive. 51% of the women at baseline reported to wash inside the vagina but this decreased to 19% during follow-up (McNemar's p<0.001). There were no changes in sexual behaviours (e.g. increased condom use) over time.
Conclusion: Vaginal probiotic use is feasible in this setting, and acceptability and adherence were high. Targeted counselling is needed to stimulate safer sex, and acceptability of investigational products by loved ones.