Acceptance of vaginal ring and oral PrEP increases in young African women

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Overall, young women and adolescent girls in Africa are using and accepting new methods of preventing sexually transmitted HIV, the researchers reported.

Of the 247 adolescent girls and young women who participated in the REACH-034 trial, 77.8% had at least moderate adherence to the use of the dapivirine-eluting monthly vaginal ring and 58.6% had at least moderate oral pre-exposure prophylaxis (PrEP), reported Gonasagrie Nair, MBChB, MPH, of the Center for Medical Ethics and Law at Stellenbosch University in Cape Town, in a press conference at the conference International AIDS Society Virtual Virtual Tour on HIV Science.

“What we saw in this study is that the adhesion was higher than what was observed in previous studies,” she said. “And that was probably due to the psychological support that came with the study.”

Of the study participants, 97% used the ring some or all of the time, with only 3% not using it at all; 50% have used the ring for a full month, Nair added. Twenty-two percent of participants said they used PrEP all the time, which means six to seven pills per week.

After 26 months of follow-up, one case of sexually transmitted HIV was detected and four of the women were pregnant, she noted.

In addition, 35% of the participants suffered from at least one other sexually transmitted disease – 28.8% were infected with chlamydia and 8.5% were infected with gonorrhea.

The study was conducted in South Africa, Uganda and Zimbabwe from February 2019 to April 2021. Non-HIV-infected and non-pregnant participants aged 16 to 21 were enrolled at four clinical trial sites. About 35% of the group were teenagers. In the first two phases of the study, they were randomized to receive either the monthly dapivirine ring or tenofovir disoproxil / emtricitabine fumarate orally daily for 6 months, then switched to the other for 6 months. month.

Participants also received counseling, based on drug level feedback. In that analysis, Nair said, levels of dapivirine indicating release greater than 0.1071 mg / day were defined as moderate adherence and levels greater than 0.1426 mg / day as high adherence. Tenofovir diphosphate levels in dried blood spots above 700 fmol / punch were defined as moderate adhesion and levels above 1200 fmol / punch as high adhesion.

Adverse events of grade 2 or higher were experienced by 78% of the participants, but Nair noted that 94.4% remained in the trial. Researchers have not observed any safety issues with the ring or PrEP.

The acceptability of preventive measures varied, with 88.5% of the group saying they liked the vaginal ring method and 63.9% saying they liked the use of oral PrEP, she added.

“We undertook this study because adolescent girls and young women are still at great risk of acquiring HIV infection,” said Nair. “Safe and effective methods that can and will be used by young women are essential. Daily oral PrEP has been approved in many countries and the dapivirine vaginal ring is currently under regulatory review in several countries. But these methods and products will only work if they are used. consistently, and young women have had difficulty complying with both oral PrEP and the vaginal ring, as has been observed in previous clinical trials. “

“The interim results of the REACH study show that adolescent girls and young women can and will use both oral PrEP and the dapivirine vaginal ring,” she continued.

“This study gives us encouraging news. Adolescent girls and young women account for the majority of new HIV infections in sub-Saharan Africa, and the WHO recently approved the vaginal ring and oral PrEP to reduce the risk of HIV infection. HIV, “the press said. Conference Moderator and President of the International AIDS Society, Adeeba Kamarulzaman, MBBS, University of Malaysia in Kuala Lumpur, Malaysia.

“We hope that these results will help accelerate efforts to make these two preventive options available, so that all girls and young women can benefit from them,” she added.

  • Ed Susman is a freelance medical writer based in Fort Pierce, Florida, United States.

Disclosures

Nair and Kamarulzaman have disclosed no connection with the industry.


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