By Sharon Atieno
Given an option between oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring (DVR), the majority of African women still prefer oral PrEP.
This is according to a Catalyzing Access to New Prevention Products to Stop HIV (CATALYST) study conducted in 28 sites across five African countries (Kenya, Lesotho, South Africa, Uganda and Zimbabwe).
In sub-Saharan Africa, women and girls account for three out of five new HIV infections. Every week, 3,100 adolescent girls and young women aged 15–24 years were infected with HIV in 2023.
The study, funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID), is an implementation study that aims to characterize and assess the implementation of an enhanced service delivery package that provides a choice of PrEP products.
Of the 3,967 women enrolled in the study, 66% of participants chose oral PrEP, 30% chose DVR and 4% did not choose any method, said Elizabeth Irungu, Regional Technical Advisor for Implementation Science at Jhpiego, during the results presentation at the HIV Research for Prevention (HIV4RP) Conference in Lima, Peru.
Oral PrEP- daily antiretroviral drugs taken to prevent HIV- can reduce the risk of HIV infection by over 90% if used consistently. DVR – a silicone ring containing dapivirine antiretroviral drug that is inserted into the vagina and replaced after 28 days- reduces infection risk by 50%.
Irungu observed that at the time of enrollment to the study, 68% of the women had never taken PrEP, 15% were former users who were coming back and 9% were pregnant while 12% were breastfeeding. Additionally, 45% were 24 years older or less and a quarter of them reported doing sex work.
“The dapivirine vaginal ring was chosen by 15% of pregnant women and 21% of breastfeeding women in countries that were permitting use in these populations,” Irungu said.
The study also found that given an option, those having multiple sex partners and using contraceptives were more likely to use the ring while participants under the age of 25 years, new PrEP users and participants who were pregnant or breastfeeding were less likely to choose it.
Participants who chose oral PrEP said they did so because it is easy to use (59%) and works well (32%); those who chose the DVR did so because it is easy to use (57%) and does not require swallowing pills (53%).
“Women are taking advantage of choice, and they are choosing a method that works for them and for some, the ring is their choice, despite its modest efficacy,” Irungu noted, adding that providing choice also did seem to bring in former prep users into the HIV prevention program.
While oral PrEP has been approved across most sub-Saharan African countries, regulatory authorities in Botswana, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, South Africa, Uganda, Zambia, and Zimbabwe have approved the PrEP ring, and regulatory submissions in other countries are under review.
The CATALYST study is ongoing and will soon produce evidence of how patterns of PrEP use change with choice of oral PrEP, the DVR and long-acting cabotegravir for HIV prevention.
