New study reports higher adherence to HIV PrEP, vaginal ring among young women
Newly presented study findings reported higher adherence to two HIV prevention methods — oral PrEP and the dapivirine vaginal ring — among adolescent girls and young women in Africa than was shown in previous trials, researchers said.
They presented the data during the International AIDS Society Conference on HIV Science.
“Current statistics indicate the ongoing vulnerability and disproportionate impact of HIV infection in adolescent girls and young women in Africa. Young women need acceptable options for HIV prevention urgently to address this problem,” Gonasagrie Nair, MBChB, MPH, protocol chair for the REACH study and senior lecturer at the Centre for Medical Ethics and Law at Stellenbosch University in South Africa, told Healio. “Oral PrEP and the dapivirine vaginal ring have proven to be efficacious in preventing HIV infection but not in younger women, and this was due to poor adherence.”
PrEP has been approved in several countries in Sub-Saharan Africa, and the dapivirine vaginal ring has been endorsed by WHO for use by women older than 18 years at substantial risk for HIV infection and is currently undergoing regulatory review, Nair noted.
“The REACH study was designed to assess whether these two products would work to prevent HIV infection in young women, be safe for use and be acceptable to them,” she said.
Nair and colleagues enrolled 247 adolescent girls and young women aged 16 to 21 years from South Africa, Zimbabwe and Uganda, who were not infected with HIV and not pregnant. During the first two study phases, they randomly assigned the participants to either monthly dapivirine ring or daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for 6 months, then switched to the second product for another 6 months. Nair and colleagues assessed safety based on grade two adverse events, adherence based on residual drug levels in returned rings and plasma dried blood spots for oral PrEP, and self-reported acceptability.
According to the researchers, most participants had at least moderate adherence to the dapivirine ring (77.8%) and oral PrEP (58.6%), whereas high adherence was observed in 50.2% of dapivirine and 22.4% of oral PrEP users. Adverse events of grade two or higher were experienced by 78% of ring users and 77% of oral PrEP users. Acceptability varied, with 88.5% liking the dapivirine ring and 63.9% liking oral PrEP.
“Young women can and are willing to use both PrEP and the vaginal ring when provided with tailored adherence support measures,” Nair said. “Both PrEP and the ring were safe, with no discontinuations of product use due to either the ring or PrEP.”