Ongoing Research

The following ongoing studies on cervical barriers and internal/female condoms are listed in reverse chronological order based on the start date of the study.

These listings are updated annually. Help us keep the list complete and up to date!

If you have updated information for a study below or know of research that is not included, please email us: info@cervicalbarriers.org.

Internal/Female Condoms

Female Condom Contraceptive (CoCo) Study

Location: South Africa

This randomized comparative prospective follow-up study aims to evaluate contraceptive effectiveness of the Cupid, Cupid 2 and FC2 female condoms. The contraceptive effectiveness will be determined for 6 months. Target enrolment is 780 volunteers. The volunteers will be followed-up monthly for up to seven months. A daily diary will be used to record menstrual pattern, acts of intercourse and details of condom usage. The primary endpoint will be the occurrence of pregnancy or use of emergency contraception, and the diary information will allow pregnancy rates to be characterised by patterns of condom use and failures (contraceptive efficacy and effectiveness rates). The study commenced enrolment in November 2019. Funding is provided by Female Health Company and Cupid, Ltd.

A Functional Performance Study of the Wondaleaf Female Condom

Randomized crossover trial
Location: South Africa

Background: The Wondaleaf female condom is a new female condom (FC) design made of polyurethane with no external or internal rings. The body of the condom is fitted by an exterior adhesive shield (figure 1) which also displays the condom when removed from the condom packaging.

Purpose: To ascertain the functional performance of the Wondaleaf FC.

The primary objective was to ascertain the functional performance of the Wondaleaf FC with primary endpoints of total clinical failure and total device failure. The secondary objectives were to gather acceptability and safety data (as determined by the number of adverse events) on each FC type.

220 women were enrolled, of whom 210 completed the study using both Wondaleaf FCs and FC2 female condoms (available in the South African public sector). The study was completed in October 2019 and data analysis is underway.

A Functional Performance Study of the Woman’s Condom 2: An adapted design of the Woman’s Condom

Randomized controlled study
Location: South Africa

This project evaluated the functional performance of the adapted Woman’s Condom design (WC2) without the foam dots.

Objectives: We aimed to assess the functional performance and safety of a modified Woman’s Condom (WC2) against the existing FC2 female condom.

Study design: This randomized clinical trial enrolled 287 women in one South African site. The primary outcome of the study was the rate of female condom failure. Participants were asked to use five of each female condom type and to collect information on use in a condom log at home and were interviewed after use of each FC type.

Publications

Beksinska M, Greener R, Mphili N, Smit J, Kilbourne-Brook M, Coffey PS. Functional performance study of an adapted design of the woman’s condom: a crossover, noninferiority, randomized clinical trial. Eur J Contracept Reprod Health Care. 2019;24(3):233–239. doi:10.1080/13625187.2019.1610940

Funder/Sponsor: PATH and UAFC
Principal Investigators: Dr M. Beksinska and Prof J. Smit
Sites: Commercial City Site

Interpersonal Communication to encourage use of female condoms in Zambia

Randomized Evaluation
Location: Zambia

Under the Expanding Effective Contraceptive Options (EECO) project, Population Services International (PSI) and its Zambian subsidiary, the Society for Family Health (SFH), registered and launched the new Maximum Diva brand Woman’s Condom (MDWC) in Zambia in February 2016. Researchers are using a randomized evaluation to measure the impact of an interpersonal communication (IPC) program—which are person-to-person or small group interactions aimed at increasing the sharing of information, feelings and experience—on self-reported knowledge, acceptability, and use of condoms in the context of the mass distribution and mass marketing campaign of the MDWC.

A baseline survey was conducted prior to the MDWC distribution and launch of the supporting marketing campaign. Researchers will randomly assign 40 wards in Lusaka to either receive an IPC program or serve as the comparison group (20 wards each). Local young people recruited and trained in IPC interventions will set up information booths in central market areas in each intervention ward, and go door to door, in order to organize groups of young people to participate in the IPC sessions. These IPC sessions will occur over a 6 month period.

Researchers will measure the impact of the IPC intervention by comparing outcomes in wards that receive the program to wards in the comparison group that do not receive the program. To measure the impact of this intervention, researchers will compare overall condom use, use of the female condom, and willingness to use a female condom between comparison and IPC wards. They will also non-randomized methods to measure the effect of the distribution and mass media campaign on contraception knowledge, attitudes and practices.

Data collection is complete and findings have been presented at the 2018 International Social and Behavior Change Communication Summit and the 2018 Population Association of America conference in April.

Manuscripts presenting the results are in process and will be submitted for publication.

This project was funded by a two year grant from USAID.

Evaluation of the national South African female condom program: Investigating factors associated with uptake and sustained use

Mixed-methods study
Location: South Africa

The evaluation uses a mixed-methods approach and has three complementary components. First, a national evaluation sample including all 265 STI Sentinel surveillance sites in the public sector and a sample of non-public sector sites (NGOs, social marketing, tertiary education, and private) are participating in a telephone survey and review of distribution statistics. A sub-sample of these sites will participate in a more intensive phase involving site visits, client and provider interviews, and collection of basic costing data.

The second component includes a cohort of 500 new female condom acceptors and 60 of their male partners for a longitudinal assessment of key outcomes related to female condom and male condom use, HIV-related behaviors, and relationship characteristics.

The third component consists of key informant interviews with policymakers and program managers.

Data collection was completed in 2016.

This 3-year grant from USAID was awarded to MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, University of the Witwatersrand, under the second round of the “Implementation Science Research to Support Programs under PEPFAR.” The HIV Centre, University of Columbia, is a collaborating partner.

Related presentations:

2015

Beksinska M, Smit J, Mabude Z, Nkosi P, Greener R, Mantell J, Kubeka M. The National Female Condom Evaluation in South Africa: Progress with rollout of female condoms in the public and non-public sector. Oral presentation. 7th South African AIDS Conference, Durban, South Africa, 9-12 June 2015.

R Greener, M Beksinska, J Smit, Z Mabude, P Nkosi, J Mantell, M Kubeka. The National Female Condom Evaluation in South Africa: National female condom distribution statistics. 7th South African AIDS Conference, Durban, South Africa, 9-12 June 2015.

Zulu B, Phungula L, Beksinska M, Smit J, Mabude Z, Nkosi P, Greener R, Mantell J, Kubeka M. The National Female Condom Evaluation in South Africa: Parallel programming of new female condoms. Oral presentation. Global Female Condom Conference, Durban, South Africa, 1-3 December 2015.

Mabude Z, Nkosi P, Mnguni N, Kubeka M, Phungula L, Beksinska M, Smit J, Mantell J. Cohort component: progress & preliminary findings, 2013. Oral presentation. Global Female Condom Conference, Durban, South Africa, 1-3 December 2015.

Beksinska M, Smit J. Female condoms – new developments. Oral presentation. Global Female Condom Conference, Durban, South Africa, 1-3 December 2015.

2016

Beksinska ME, Nkosi P, Kubeka M, Smit JA, Mabude Z, Mantell JE, Greener R, Phungula L, Marumo E, Chidarikire T, Rodríguez H. Who has heard of or ever used the female condom in South Africa? The National Female Condom Evaluation in South Africa. Poster presented at 21st International Aids Conference; 2016 July 18-22; Durban, South Africa.

Mabude Z, Beksinska M, Mantell JE, Nkosi P, Mnguni N, Greener R, Smit J, Jacobson L. “Will he let me use a female condom? Will sex be the same?” Attitudes and experiences of female condom users attending selected public-sector health facilities in KwaZulu-Natal, South Africa. Poster presented at 21st International Aids Conference; 2016 July 18-22; Durban, South Africa.

2017

Lazarus N, Nkosi P, Milford C, Beksinska M, Mabude Z, Zulu B, Phungula L, Kubeka M, Zwane Z, Msawoni N, Greener R, Smit J, Hawkins J, Mantell JE. Targeting female condoms to young people in higher education institutions in South Africa: What do policy makers and program managers think? HEAIDS Conference, Durban, South Africa, 9-11 June 2017. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Zulu B, Beksinska M, Phungula L, Mabude Z, Nkosi P, Greener R, Smit R, Kubeka M. Parallel programming of different types of Female Condoms: Insight from The National Female Condom Evaluation in South Africa. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Milford C, Lazarus N, Nkosi P, Kubeka M, Zulu B, Zwane Z, Msawoni N, Phungula L, Mabude Z, Smit J, Beksinska M, Mantell JE. Facilitators and barriers to the female condom program in South Africa: Perspectives of policy-makers and program managers. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Phungula L, Beksinska M, Nkosi P, Kubeka M, Mabude Z. To assess the availability and accessibility of Information, Education and Communication material and demonstration models for Female Condom promotion in health facilities in South Africa. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Khuzwayo M, Nkosi P, Greener R, Mabude Z, Beksinska M, Smit J. Prevalence of reported anal sex and condom use in a cohort of new female condom users in KwaZulu-Natal. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Lazarus N, Beksinska M, Nkosi P, Mabude Z, Smit J. The National South African STI sentinel surveillance sites: Experiences of using the sample for the South African National Female Condom Evaluation. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Phume N, Beksinska M, Nkosi P, Mabude Z. Getting female condoms to facilities: A review of ordering and delivery systems in South Africa. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Nkosi P, Kubeka M, Phungula L, Beksinska M, Smit J, Mabude Z, Mantell JE, Marumo E, Chidarikire T. The National Female Condom Evaluation in South Africa: knowledge, attitudes and practices of providers working in primary health care facilities in South Africa. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Beesham I, Beksinska M, Smit J, Mabude Z, Greener R, Nkosi, Mantell JE. HIV positive women and female condoms: Do HIV positive women choose female condoms and why? 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Mabude Z, Beksinska M, Nkosi P, Mantell JE, Greener R, Evans S, Smit J. Are men on board? Attitudes and experiences with female condom use among a Cohort of male partners of women who are new female condom users in KwaZulu-Natal. 8th South African AIDS Conference, Durban, South Africa, 13-15 June 2017.

Beksinska M, Mabude Z, Nkosi P, Smit J, Mantell JE, Greener R, Zulu B, Kubeka M, Phungula L, Marumo E, Chidarikire T. The National Female Condom Evaluation in South Africa:- Overview of key findings in the progress of rollout of female condoms in the public and non-public sector. 9th International AIDS Conference on HIV Science, Paris, France, 23-26 July 2017.

Beksinska M, Mabude Z, Nkosi P, Mantell JE, Greener R, Smit J. A Cohort of New Female Condom Acceptors: Protected sex acts and mixing female and male condom use. 9th International AIDS Conference on HIV Science, Paris, France, 23-26 July 2017.

Twenty Years of the South African National Female Condom Program: What We Can Learn to Inform the Future Direction of Biomedical HIV Prevention Technologies. Satellite session. 9th International AIDS Conference on HIV Science, Paris, France, 23-26 July 2017.

Beksinska M, Mabude Z, Nkosi P, Mantell JE, Greener R, Smit J, Zulu B,Milford C, Kubeka M, Lazarus N, Phungula L, Marumo E, Chidarikire T. Comprehensive Condom Programming of Male and Female Condoms in South Africa: Results of the National South African Female Condom Evaluation. Oral presentation. 13th AIDS Impact Conference, Cape Town, South Africa, 13-15th November 2017.

Related publications

Beksinska M, Nkosi P, Mabude Z, Smit J, Zulu B, Phungula L, Greener R, Kubeka M, Milford C, Lazarus N, Jali Z, Mantell JE. Twenty years of the female condom program in South Africa: past, present and future. South African Health Review, 2017. Chapter 14. In: Padarath A, Barron P, editors. South African Health Review 2017. Durban: Health Systems Trust; 2017. URL: http://www.hst.org.za/publications/south-african-health-review-2017. Pg 147.

2019

Beksinska M, Zulu B,Nkosi P, Mabude Z, Smit J. Offering choice in female condoms: The South African Experience. Int J STD AIDS. 2019;30(10):985–990.

2020

Beksinska M, Nkosi P, Mabude Z, Mantell JE, Zulu B, Milford C, Smit JA. Lessons from the evaluation of the South African National Female Condom Programme. PLoS One. 2020 Aug 13;15(8):e0236984.

A pilot study evaluating the functionality of the Panty Condom

Pilot functionality evaluation
Location: South Africa

There are no published data on the performance of the Panty Condom (PC). We conducted a pilot study among experienced female condom users in Durban, South Africa to assess the functional performance of the PC. Nineteen participants were recruited and returned for a follow-up survey after five uses of the PC.

The study was conducted by MRU (MatCH Research Unit) and is funded by the Universal Access to Female Condoms (UAFC) Joint Programme and I+Solutions.

Results of the trial have been accepted for publication:

Beksinska M, Smit J, Mphili N,Greener R, Maphumulo V. The Panty Condom: A pilot study of the function and acceptability of an alternative female condom design. International Journal of STD & AIDS. 2019;30(11):1080–1086. doi:10.1177/0956462419845543

Performance and failure mode study comparing the Woman’s Condom and the FC2 female condom, and using prostate-specific antigen as a biomarker of semen exposure

Randomized crossover study
Location: United States

This study is a randomized crossover study comparing self-reported clinical failure rates among 330 couples using the Woman’s Condom and the FC2 female condom. The secondary objects are: to compare the ability of the Woman’s Condom and the FC2 to prevent vaginal exposure to semen, as indicated by detection of PSA within the vagina; to calculate the sensitivity and specificity of reported failures for the presence of semen, using PSA as the indicator of the presence of semen; and to compare acceptability of the Woman’s Condom and FC2.

The clinical portion of this study was completed in 2011. The statistical report has been submitted to the FDA. A manuscript presenting study results is in process.

This study was implemented by California Family Health Council; CONRAD is the regulatory sponsor.

Related publications:

Mauck et.al. Critical next steps for female condom research – report from a workshop. Contraception. 2009 May;79(5):339-44.

Woman’s Condom safety and contraceptive efficacy study

Contraceptive effectiveness study
Location: 10 research sites in the United States

Begun in 2011, this is a multi-center, open-label, non-comparative study testing the safety and efficacy of the Woman’s Condom among 450 women recruited from 10 research centers in the United States. Participants agreed to use the Woman’s Condom as their primary contraceptive method for 6 months. A subset of women participated in a sub-study using prostate specific antigen (PSA) as a biomarker of semen exposure. These PSA data will be compared to PSA data collected as part of the CONRAD comparative performance and failure mode study (see previous entry), to build evidence of the sensitivity and specificity of PSA to measure female condom failures.

The clinical portion of this study was completed in late 2012, and data analyses are underway. The clinical study report is being drafted for FDA review.

This study was implemented by NICHD; CONRAD is the regulatory sponsor.