The quest for the (vaginal) ring

 

 

The HIV prevention tablet is now available in South Africa but popping a pill every day to stay HIV-negative may not be for everyone. For young women, hassle-free alternatives are on the horizon.


A vaginal ring inserted monthly could reduce women’s risk of contracting HIV by 63%, according to a recent study.

The ring is loaded with the antiretroviral drug (ARV) dapivirine, which is slowly released into wearers’ blood to help prevent HIV infection. The flexible, silicon band — developed by the nonprofit organisation International Partnership for Microbicides (IPM) — is the first long-acting form of treatment that HIV-negative women can take before being exposed to HIV to reduce their chances of contracting the virus. The treatment, which is also known as pre-exposure prophylaxis (PrEP), can be easily replaced at home each month.

In 2016, research conducted among almost 2 000 women in Uganda and South Africa found that when women inserted the ring and kept it in for the full month, the device reduced their risk of infection by 31%.

The results of the study were published in The New England Journal of Medicine. Another similar study — also published in the journal and conducted in four countries in southern and East Africa — had similar findings.

But both trials found differences in how well the ring worked for women based on age — mostly because women younger than 21 were less likely to use the ring consistently, researchers hypothesised, and they were likely having more sex than older women.

After the initial study concluded in Uganda and South Africa, scientists continued to follow ring-using women who had remained HIV negative during the trial for at least one year. They found that not only did 95% — 12% more than in the previous study — of women use the ring at least some if not all of the time, but also that the silicon band was more effective at protecting them from HIV than previously thought. The research was presented at the South African Aids Conference in May. When researchers compared the women’s results with computer simulations of what would have been their HIV risk without the loops, they found that the ARV-containing ring reduced new infections among the group by almost two-thirds.

IPM’s chief medical officer Annalene Nel says the organisation plans to submit the ring for approval to the South African Health Products Regulatory Authority (Sahpra) and its United States counterpart, the Food and Drug Administration, later this year.

The band is already being reviewed by the European Union’s drug authority, the European Medicines Agency. If the agency greenlights the ring’s public use in the EU, IPM will submit it for World Health Organisation (WHO) prequalification. This kind of WHO approval often allows devices to be used in low- and middle-income countries that don’t have national regulators with the capacity to quickly approve new medicines or products.

The IPM expects the ring to be WHO-prequalified by mid-2020 and approvals from several national regulators in Africa to follow, says the senior director of IPM external affairs Africa, Leonard Solai.


The IPM is also in the early phases of developing two other dapivirine-containing rings that could be left in for three months at a time or could combine the HIV protection of an ARV with a long-acting contraceptive. A two-in-one ring could cut down costs for women, for instance, the money spent on transport to collect birth-control from clinics that are at times few and far between.

But, what does this form of PrEP mean for women in South Africa?

Three times as many young women between the ages of 20 and 24 are HIV-positive compared with men their same age, preliminary results of the Human Sciences Research Council’s latest household HIV survey show.

The department of health wants to slash the number of new infections by rolling out PrEP to young women in the form of a daily HIV prevention pill as part of the country’s latest HIV plan.

But studies have shown that young women’s adherence to the pill is considerably lower than that of, for instance, men who have sex with men, because young women often don’t perceive themselves to be at risk of HIV.

Because the dapivirine ring only needs to be replaced once every month and maybe in the near future, once every three months, it could increase womens’ adherence to PrEP — and consequently how well it works for them.

So, when can we expect a rollout of the one-month dapivirine ring in the country?

Nel says there’s still a long way to go before the ring would be available for public use — the IPM would first have to get Sahpra approval. “We’ll probably have to go into a fourth round of trials,” she concludes.

These are unprecedented times, and the role of media to tell and record the story of South Africa as it develops is more important than ever. But it comes at a cost. Advertisers are cancelling campaigns, and our live events have come to an abrupt halt. Our income has been slashed.

The Mail & Guardian is a proud news publisher with roots stretching back 35 years. We’ve survived thanks to the support of our readers, we will need you to help us get through this.

To help us ensure another 35 future years of fiercely independent journalism, please subscribe.

Roxy de Villiers
Roxy De Villiers
Writer, guitarist, sportswoman, and reporter. Lover of narratives and the politics thereof, noting that “everything is dangerous” as told by my mentor and friend. Proud hockey enthusiast.
Bhekisisa team
Bhekisisa Team
Health features and news from across Africa by Bhekisisa, the Mail & Guardian's health journalism centre.
Advertising

Two dead in new ANC KwaZulu-Natal killings

A Mtubatuba councillor and a Hammarsdale ANC Youth League leader were shot yesterday near their homes

Inside Facebook’s big bet on Africa

New undersea cables will massively increase bandwidth to the continent

No back to school for teachers just yet

Last week the basic education minister was adamant that teachers will return to school on May 25, but some provinces say not all Covid-19 measures are in place to prevent its spread

Engineering slips out of gear at varsity

Walter Sisulu University wants to reprioritise R178-million that it stands to give back to treasury after failing to spend it
Advertising

Press Releases

Coexisting with Covid-19: Saving lives and the economy in India

A staggered exit from the lockdown accompanied by stepped-up testing to cover every district is necessary for India right now

What Africa can learn from Cuba in combating the Covid-19 pandemic

Africa should abandon the neoliberal path to be able to deal with Covid-19 and other health system challenges likely to emerge in future

Road to recovery for the tourism sector: The South African perspective

The best-case scenario is that South Africa's tourism sector’s recovery will only begin in earnest towards the end of this year

Covid-19: Eased lockdown and rule of law Webinar

If you are arrested and fined in lockdown, you do get a criminal record if you pay the admission of guilt fine

Covid-19 and Frontline Workers

Who is caring for the healthcare workers? 'Working together is how we are going to get through this. It’s not just a marathon, it’s a relay'.

PPS webinar Part 2: Small business, big risk

The risks that businesses face and how they can be dealt with are something all business owners should be well acquainted with

Call for applications for the position of GCRO executive director

The Gauteng City-Region Observatory is seeking to appoint a high-calibre researcher and manager to be the executive director and to lead it

DriveRisk stays safe with high-tech thermal camera solution

Itec Evolve installed the screening device within a few days to help the driver behaviour company become compliant with health and safety regulations