Anti-HIV methods give young SA women the ring of confidence: study

15 July 2021 - 15:59 By TimesLIVE
The dapivirine ring releases an antiretroviral in the vagina and lasts a month. File photo.
The dapivirine ring releases an antiretroviral in the vagina and lasts a month. File photo.
Image: International Partnership for Microbicides

Adolescent girls and young women in SA say they are happy to use HIV-prevention products consistently, according to interim results of a study of two different methods.

Nearly all of the 16 to 21-year-olds who signed up for the study said a daily antiretroviral (ARV) pill or an ARV vaginal ring that lasts a month worked well for them.

The Reach (Reversing the Epidemic in Africa with Choices in HIV prevention) study, being conducted in SA, Uganda and Zimbabwe by the Microbicide Trials Network, found 97% of participants used the products some or all of the time.

The findings were reported on Thursday at a media briefing by the International Aids Society, which is holding its annual conference virtually next week.

During the six months the young women — including groups at Wits Reproductive Health and HIV Institute in Johannesburg and the Desmond Tutu HIV Foundation research site in Crossroads, Cape Town — were asked to use the monthly dapivirine ring, 88% said they liked it.

During the period when they were assigned to use Truvada as oral pre-exposure prophylaxis (PrEP), 64% said they liked the daily pill-taking regimen.

The research team attributed the positive reaction to support measures and the non-judgmental counselling approach provided as part of the study.

Prof Gonasagrie (Lulu) Nair says young women need to feel empowered and have the agency to make choices.
Prof Gonasagrie (Lulu) Nair says young women need to feel empowered and have the agency to make choices.
Image: Stellenbosch University

Reach co-chairperson Gonasagrie (Lulu) Nair, from the Centre for Medical Ethics and Law in the Stellenbosch University faculty of medicine and health sciences, said the results exceeded researchers' expectations.

“Yet at the same time, it's not surprising to find that these young women have the capacity and desire to protect themselves against HIV. They simply need to feel empowered and have the agency to make choices based on what they feel is right for them,” she said.

Globally, more than half of all people living with HIV are women, and in Sub-Saharan Africa women account for more than 60% of adults with HIV. Rates of infection are especially high among adolescent girls and young women.

According to UNAids, in 2020 one in four new infections in Sub-Saharan Africa were in young women aged 15-24, who make up only 10% of the population.

After trying both products in the Reach study, participants were asked to choose one to use for another six months. This part of the study has not yet ended.

Adherence to oral PrEP was based on levels of drug in blood samples taken at each monthly visit. For the ring, researchers looked at the amount of residual drug left in rings participants returned after a month of use.

Each ring contains 25mg of the ARV dapivirine, about 4mg of which is released into the vagina when used continuously for 28 days.

Study participants' monthly visits all include a meeting with a counsellor, and participants can also choose from a menu of additional forms of support, including daily text messages or weekly check-ins by phone; having a “peer buddy”; and adherence support groups.

Adherence test results are presented in terms of what they may mean for the level of protection they are receiving and are given without judgment.

“We've tried to empower these young women by letting them take control of their own health and behaviours and to make their own decisions,” said Reach co-chairperson Kenneth Ngure, from Jomo Kenyatta University in Nairobi, Kenya.

“If participants don't want to or cannot use either the ring or oral PrEP, we simply want to understand the reasons why, while also seeing what kind of support may help. And if they change their mind, that's OK as well, because as their circumstances change, so will their needs and preferences for HIV prevention.”

In anticipation of the ring's potential approval by the US Food and Drug Administration, the latest World Health Organisation guidelines for HIV prevention recommend the device as an additional HIV prevention choice for women at substantial risk of HIV.