Clinical Trials Logo

Clinical Trial Summary

HIV remains a global pandemic with 37 million infected. In western Kenya, 16% of women in the general population and 29% of the poorest women have HIV. The HIV and sexually transmitted infection (STI) epidemics overlap with broader reproductive health concerns. Menstrual hygiene management is a big problem in low- and middle-income countries and a lack of menstrual products negatively impacts women's work-life. This comes from cultural taboos, stigma, and discrimination, promoting secrecy around menstruation, high cost of menstrual products, use of traditional materials (e.g. rags, cotton wool, etc.) causing leakage and odor, and lack of water and safe hygiene facilities. Menstrual cups designed for use during sex may help women prevent Bacterial vaginosis (BV) and STIs through hygienic period practices, and may help them avoid bad practices in an attempt to maintain vaginal dryness. The goal of this interventional trial is to test the impact of menstrual cups on vaginal microbiome, BV, and STIs of poor women at high risk for STIs and HIV. We predict to see 25% less BV, our primary outcome, over one year. This trial aims to learn more about the safety of the intervention, and understand what is needed to fully implement the program.


Clinical Trial Description

In western Kenya, HIV prevalence is 16% among women in the general population, and 29% among the most economically constrained women. The HIV/STI epidemic overlaps with broader reproductive health concerns. Menstrual hygiene management (MHM) is a pervasive problem across low- and middle-income countries. In Phillips-Howards' survey of over 3,400 women in rural Kenya, two-thirds of women in impoverished settings state they depend on their sexual partners to provide branded products. Economically vulnerable women at high risk for HIV and STI are uniquely challenged because many continue to have sex during menses, and engage in harmful MHM practices, such as vaginal insertion of sponges and cotton to maintain dryness. Led by co-investigator Phillips-Howard, a cluster-randomized study of 644 girls aged 14-16 years old in western Kenya compared reusable menstrual cups to usual menstrual practice and counseling; after 9 months, menstrual cup use resulted in 35% reduction (p=0.034) in Bacterial vaginosis (BV) prevalence and 56% reduction (p=0.001) in STI prevalence compared to other materials. Among 431 Kenyan secondary schoolgirls aged 14-21, we observed cloth use for menses was associated with a 1.72-fold increased odds of non-optimal vaginal microbiome (CST-IV vs. CST-I: aOR=1.90; 95% CI: 1.03-2.86). Over 18 months of observation prior to COVID-19, girls using menstrual cups to manage menses had 20% higher occurrence of Lactobacillus crispatus dominated CST-I (aRR=1.29; 95% CI: 1.08-1.53, controlling for age, and baseline STI and sexual activity). Menstrual cups designed for use during intercourse may help women prevent BV and STIs through hygienic menstrual practices and avoidance of harmful practices to maintain vaginal dryness during menses. Objective: This single-arm interventional trial seeks to evaluate the preliminary efficacy of menstrual cups on non-optimal vaginal microbiome (VMB), BV, and STIs of economically vulnerable women at high risk for STIs and HIV, assess safety profile, and understand implementation needs. In Aim 1, we will evaluate the impact of menstrual cups on VMB, BV, and STIs among 402 economically vulnerable women in semi-urban Kenya. In Aim 2, we will conduct integrated surveillance for enhanced detection of safety endpoints, risk of cup contamination, and mitigating or facilitating water, sanitation, hygiene (WASH) factors. In Aim 3, we will identify constructs for successful MHM program implementation using an implementation science framework. Future Directions: The biological protection suggested in a randomized setting, and our findings that unhygienic cloth use is associated with non-optimal VMB, while menstrual cup use increases optimal VMB composition, together provide rational justification for this trial, of relevance to economically challenged women globally. Assessing preliminary efficacy signal in conjunction with implementation characteristics and adverse events, will generate a comprehensive and necessary foundation for definitive assessment of effectiveness of menstrual cups as a multipurpose intervention for MHM, and to reduce BV and STIs. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT05666778
Study type Interventional
Source Rush University Medical Center
Contact
Status Active, not recruiting
Phase Phase 2
Start date February 13, 2023
Completion date July 31, 2027

See also
  Status Clinical Trial Phase
Completed NCT03930745 - Suppression Of Bacterial Vaginosis (BV) [SUBVert] Phase 2
Completed NCT02863536 - A Study of the New Medical Device Polybactum® N/A
Completed NCT03187457 - PreFem: "What Happens to the Vaginal Microbiota When a BV Infection is Treated With Metronidazole?" N/A
Recruiting NCT02185456 - Validation of a Novel Diagnostic, Prognostic Assay for Bacterial Vaginosis Phase 0
Completed NCT02150655 - Study of the Microbiota, Metabolome, and Environmental Toxins in Relation to Reproductive Health in Rwandan Women Phase 0
Completed NCT01450462 - Vitamin D and Sexual Health N/A
Recruiting NCT01558388 - Probiotic Versus Placebo as Adjuvant for Bacterial Vaginosis Treatment During Pregnancy Phase 4
Completed NCT01471457 - Trial of Trimosan Gel Effect on Pessary-associated Bacterial Vaginosis Phase 2/Phase 3
Not yet recruiting NCT00889356 - Evaluate Efficacy, Tolerability & Safety of Combination of Clindamycin and Ketoconazole for the Treatment of Mixed-Type Vaginosis, Bacterial Vaginosis and Candidiasis Phase 3
Completed NCT00556179 - Lactoserum (Dermacyd Femina®) and Prevention of Recurrence of Bacterial Vaginosis Phase 4
Completed NCT00545181 - Recurrent Bacterial Vaginosis and Vaginal Acidifying Gel Trial N/A
Completed NCT02236156 - Efficacy and Safety Study of SPL7013 Gel to Prevent the Recurrence of Bacterial Vaginosis (BV) Phase 3
Not yet recruiting NCT05434104 - The LISA (Lactoferrin InStead of Antibiotics/Antifungals) Feasibility Study N/A
Completed NCT01335373 - Observational Program Neo-Penotran® Forte N/A
Completed NCT00752193 - Safety and Efficacy of a Vaginally Administered Probiotic Lactobacilli Delivery System. N/A
Active, not recruiting NCT00536848 - The Effect of Probiotics on the Immune Status, Diarrhea and Bacterial Vaginosis Cure Rate Among HIV Patients Phase 2/Phase 3
Completed NCT00510614 - Tinidazole for Recurrent Bacterial Vaginosis: A Pilot Study Phase 0
Suspended NCT00207480 - Brief, Behavioral Intervention to Reduce Douching Among Adolescent and Young Women Phase 1
Recruiting NCT05278130 - Serial Screening and Treatment of Bacterial Vaginosis Trial N/A
Completed NCT02905890 - The Effect of Norethisterone Enanthate on Recurrent Bacterial Vaginosis Phase 4