Young African women prefer vaginal rings for HIV prevention — new study
Vaginal rings seem to be the most popular choice among women who want to prevent HIV infection, rather than daily pills, a new study has revealed.
New results from the REACH (reversing the epidemic in Africa with choices in HIV prevention) study, which began early in 2019 and seeks to understand the HIV prevention needs and preferences of young women in Africa, show that the majority, or 67% of them, chose the vaginal ring over daily HIV pre-exposure prophylaxis pills.
About 250 women from SA, Zimbabwe and Uganda, aged 16-21, were given a choice between the daily pre-exposure prophylaxis Truvada and a Dapivirine ring. They also had an option not to use either and could change their minds at any time.
The results that were presented at the Conference for Retroviruses and Opportunistic Infections, held virtually this week, showed that 67% chose the ring while 31% chose the daily pill. Only 2% opted to use neither.
Thirty study participants switched products during the study. Those who chose oral PrEP over the ring were among those who had used it most regularly during the six-month period when they were assigned to that regimen.
Kenneth Ngure, the study protocol chair who reported the results at the conference, said the study was just a small example of what the “potential impact could be in the realm of HIV prevention, simply by allowing young women and girls the ability to choose”.
“We know that with contraceptives, having a range of options makes it more likely of there being one that will meet an individual’s needs and preferences, and that it can and will be used. Of particular relevance are the study’s findings suggesting that the monthly Dapivirine ring could be a viable option for those adolescent girls and young women who can’t or don’t want to take daily oral PrEP.”
Researchers observed that during the first two periods of the study, when participants used the ring and oral PrEP, adherence to both products was higher than what had been seen in previous trials involving young women.
Though the number of young women adopting and staying on oral PrEP was lower in this study, researchers are convinced that it “has demonstrated that among those with a preference for oral PrEP, it’s a method that can work very well”.
Young women need to be allowed to make their own informed decisions about what they feel is best for them.Gonasagrie Nair, study protocol chair
Gonasagrie Nair, study protocol chair and senior lecturer at the centre for medical ethics and law at Stellenbosch University, said the approaches used in this study seemed to work well for the young women and girls.
“What may be feasible or scalable at the community level and by health systems is still to be determined, and will likely depend a lot on capacity. But if there’s one thing that must be considered, it’s that young women need to be allowed to make their own informed decisions about what they feel is best for them.”
Mitchell Warren, director at AVAC — a New York-based NGO that advocates for HIV prevention to end Aids — said the new data reinforces the power of choice. At a time when regulatory agencies, policymakers and funders are reviewing inclusion of the Dapivirine vaginal ring in HIV prevention, “we must recognise that the most effective intervention is the one someone picks for themselves among an array of effective choices”.
“REACH provides critical endorsement of both the ring and daily oral PrEP as two safe and effective options that many women need and can use, and of the need to provide multiple options from which women can choose.”
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