Preferences for bacterial vaginosis treatment in the United States and South Africa: a qualitative study

To characterize preferences for treatment options for bacterial vaginosis in two geographically distinct populations. Non-pregnant participants were recruited from Massachusetts General Hospital (MGH) in Boston, US, and both non-pregnant and pregnant participants from a clinical research site in Umlazi, South Africa. In-depth interviews (IDIs) (MGH and Umlazi) and focus group discussions (FGDs) (Umlazi only) were conducted using a semi-structured discussion guide to assess perceptions and preferences for different BV treatment formulations, as well as characteristics of an ideal treatment. All non-pregnant participants had a history of treatment for BV, but pregnant participants did not. In-depth Interviews and FGDs were translated (Umlazi only), transcribed and coded in Atlas.ti, using both inductive and deductive methods. Thematic analysis was performed using a constructivist paradigm. Between August 2023 and February 2024, 60 cisgender women and one non-binary participant, aged 18 to 50, were enrolled from the two study sites. Themes were broadly similar across the two geographies: 1) treatment for BV should be easy to access and to use, 2) treatment should have both immediate and long-term efficacy, and 3) having and treating BV is a source of embarrassment and stigma that impacts sexual relationships. In South Africa, systemic treatment options, such as oral or injectable medications were preferred, while topical/intravaginal options were preferred in the US. Also differing was a finding of stigma in South Africa related in part to concern that BV would be perceived as a sexually transmitted infection or a sign of infidelity, which was not reported as a concern in the US. Our findings suggest that many preferences around treatment for BV are shared across different contexts: women want treatments that work, but also treatments that fit their lives, that don’t embarrass them, that don’t trigger conflict, and that feel worth the effort. Many preferences around treatment for BV are shared across geographies: women want treatments that have prolonged efficacy and that do not disrupt their lives.