A ring for HIV prevention
Following the EMA or European Medicines Agency’s positive opinion on the dapivirine vaginal ring in July 2020, the World Health Organisation (WHO) has also recommended the dapivirine ring (DVR) as a new choice for HIV prevention for women at risk of HIV infection. The WHO made this recommendation in January 2021 after prequalifying the ring in November 2020 in recognition of its efficacy and safety.
What is “the ring”
This dapivirine vaginal ring is an HIV prevention option designed for cisgender women. The ring is worn inside the vagina for up to 28 days, after which it should be replaced by another. The ring is made of silicone and is flexible enough for easy and comfortable insertion into the vagina. Once inserted, the ring continuously releases the antiretroviral drug dapivirine into the vagina, which helps protect women from HIV infection when exposed during vaginal sex. Results from two studies (ASPIRE and Ring) showed modest protection against HIV acquisition by around 30%. The ring was most effective in women over the age of 21 who had higher adherence.
Why the ring?
Unfortunately, due to a number of factors, some women are unable to negotiate the use of protective methods during sexual encounters. Still others are unable to access oral PrEP and other prevention products. As a discreet prevention intervention, the ring is an option that can meet the unique needs and preferences of women. Also, it is important to know that we cannot have a single HIV prevention method that will meet the needs of all women at risk, so the more choices the better!
What the ring does not do
Despite the ring being another breakthrough in HIV prevention, it is important to know that the ring does not prevent unwanted pregnancy or the transmission of sexually transmitted infections.
The ring introduction in Malawi
Malawi is still conducting two studies on the dapivirine vaginal ring at two sites in the districts of Lilongwe and Blantyre. International Partnership for Microbicides (IPM) and WHO are working together to submit applications for regulatory review of the ring in African countries that participated in research and where public need and demand for rollout is high. Malawi’s regulatory authority will work with WHO to accelerate the review of the ring for introduction. Other countries that stand to benefit from the first phase roll out of the ring are Kenya, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe.
Learning from Oral PrEP; ACT and ACT NOW
It is imperative that we protect the gains we have made in the field of HIV prevention and treatment, even as we acknowledge the obstacles wrought by the COVID-19 pandemic. Presently, Malawi is on track to roll out other HIV prevention options such as oral Pre-Exposure Prophylaxis (PrEP). The Ministry of Health and Population can use the lessons learned from this rollout process to expedite the ring’s introduction in our country.
PEPFAR has committed to support the introduction of dapivirine ring in Malawi. This will include (but is not limited to) supporting the development of guidelines and policy and supply chain management. The Ministry of Health should therefore leverage this opportunity to accelerate the ring’s introduction. Subsequently, the ring should also be included in the country’s HIV prevention guidelines. Civil Society Organisations should work with all relevant stakeholders to ensure the timely introduction of the ring. Even more importantly, women should take a leading role in setting priorities for the ring’s introduction. Indeed, it is urgent that women in Malawi are able to access this prevention option as soon as possible.