# Multipurpose vaginal rings: preferences from a national discrete choice experiment survey among US women

## TL;DR

A survey of US women found strong interest in a nonhormonal vaginal ring that prevents pregnancy, HIV, STIs, and bacterial vaginosis, with preferences shaped by personal and contraceptive history.

## Contribution

This study provides novel insights into US women's preferences for a nonhormonal multipurpose prevention vaginal ring, informing its development.

## Key findings

- Participants valued contraceptive effectiveness more than HIV or STI prevention effectiveness.
- Younger women and those concerned about HIV prioritized higher effectiveness for pregnancy and HIV prevention.
- A nonhormonal formulation was important to women averse to hormonal contraception, and 73% were likely to use the ring at moderate protection levels.

## Abstract

We assessed US women's preferences to inform development of a novel nonhormonal multipurpose prevention technology (MPT)—a vaginal ring to prevent pregnancy, HIV, sexually transmitted infections (STIs), and bacterial vaginosis (BV).

In cross-sectional online surveys with US women ages 18–49 currently/interested in using contraception, we conducted a discrete choice experiment (DCE) comprising 7 MPT ring attributes. Mixed multinomial logit models examined relative attribute importance and sub-population preferences.

Of 2,105 survey completers (mean age 31) from all 50 states (Dec 2023 to Jan 2024), 53% were married/cohabiting, 57% had ≥1 child, 43% ever had an unintended pregnancy, and 9% had an STI in the past year. Participants valued effectiveness for contraception about twice as much as for HIV prevention and about 3 times that of STI prevention. Younger women (18–29 vs. 30–49) desired higher pregnancy and HIV prevention effectiveness. Women who were worried about HIV valued effectiveness for HIV and pregnancy similarly. While most women valued BV prevention and no menstrual side effects, a nonhormonal formulation mattered only to women averse to hormonal contraception (61%) and on-demand use (vs. continuous-use only) was not preferred. Women were willing to trade off some pregnancy prevention effectiveness for other desired attributes. Overall, 73% reported being likely/very likely to use a nonhormonal MPT ring at moderate protection levels (80% pregnancy, 50% HIV/STIs).

Interest in an MPT ring was strong, even with conservative effectiveness estimates. Preferences and desired levels of prevention effectiveness and nonhormonal options were shaped by contraceptive history and personal context.