A contraceptive vaginal ring that can also stop HIV transmission will help turn the tide against the virus, according to new research.
Not only does the ring stop the user from acquiring HIV, but it also prevents unplanned pregnancy.
Research conducted on Dapivirine, the ring which is inserted into the vagina, has shown that it is safe and effective at preventing HIV acquisition.
PrEP is currently offered as an oral or pill-based HIV prevention method to sexually active HIV-negative individuals who are at significant risk of acquiring HIV infection.
According to the Kenya AIDS Strategic Framework 2020/21-2024/25, about 1.5 million people are living with HIV in Kenya.
The main mode of HIV transmission in the country is through sexual contact and accounts for 80 per cent of all new HIV infections.
National Aids Control Council (NACC) data indicates that adolescents and young people aged 15-29 years account for 61 per cent of adult new HIV infections.
In an effort to reduce the rate of HIV infections, the Ministry of Health introduced PrEP and HIV self-testing on May 4, 2017.
Estimates by www.prepwatch.org show that between 110,000 and 112,000 Kenyans are using PrEP.
PrEP use has however been associated with declining condom use and the risk of increased incidence of sexually transmitted infections (STIs).
Researchers have attributed the increase to the tendency by users to participate in unprotected or condom-less sex.
Speaking at the Media for Environment, Science, Health and Agriculture (MESHA) science cafe in held in Nairobi on August 27, 2021, Prof Kenneth Ngure presented findings from the REACH study that showed STI incidence in a third of enrolled participants.
“Study findings indicated that at least one in three women that took part had an STI at enrollment,” said Prof Ngure, who heads the Department of Public Health at Jomo Kenyatta University of Agriculture and Technology (JKUAT).
The academic and researcher however clarified that the increase in STIs had also been noted before PrEP was provided to the study participants.
“There has also been an increase in STI testing among PrEP users. Therefore, the current increase cannot only be attributed to PrEP use. This increased testing was not happening before and hence this reported increase in STIs needs to be evaluated more carefully,” said Prof Ngure.
He also presented study findings that showed that the adherence to oral PrEP and the vaginal ring was higher than expected among African adolescent girls and young women.
Use of Prep and Vaginal Ring Is Higher Than Expected
Scientists have now combined the two drugs in an effort to resolve the twin challenges of increased incidence of unplanned pregnancies and STIs posed by the promotion of PrEP use.
This groundbreaking innovation is one of the highlights of the recently held International AIDS Society (IAS) 2021 conference.
IAS is a global association composed of professionals engaged in HIV health care and related sectors in more than 170 countries.
Among the more than 11,600 IAS members are clinicians, researchers, people living with HIV, service providers, policymakers and others. It aims to reduce the global impact of HIV-AIDS through collective advocacy.
The conference has previously been held as a physical meeting but was restricted to a virtual session this year due to health concerns on the ongoing COVID-19 pandemic.
Prof Ngure said the results of a phase 1 trial showed the three-month ring was a safe method for preventing HIV transmission in women.
“Results of a phase 1 safety study that involved the participants using three different Dapivirine rings, which were 25 mg for a month, 100 mg for 3 months and 200 mg for three months,” said Prof Ngure.
“Another phase 1 study of the 90 days of three-month DPV/LNG vaginal ring found that the ring was well-tolerated and delivered high levels of tenofovir which prevents HIV spread, and levonorgestrel, the pregnancy prevention drug,” added Prof Ngure.
The academic said the experimental combination of the HIV prevention drug and a contraceptive within a 3-month vaginal ring shows promise in preventing HIV transmission and unplanned pregnancy.
“The vaginal ring remains in the vagina after insertion and slowly releases the drug slowly into the region for one to three months, depending on the type and dosage. Most partners who used it reported not feeling it in the vagina after insertion,” Prof Ngure said.
He said women should not remove the ring due to activities like washing as it, “results in an immediate reduction of the drug and corresponding effectiveness in the vaginal region”.
The academic and researcher said the improved technology had the potential to play a major role in HIV prevention.
“When you have a drug that has HIV prevention and contraception capacity, then you’ll be addressing the two issues of avoiding unplanned pregnancy and acquisition of HIV infection. We think it has the potential to significantly reduce both cases if properly used,” said the academic and researcher.
To reduce stigma and encourage increased uptake of PrEP and the vaginal rings, scientists at IAS 2021 urged health care policymakers and service providers to simplify the way clients access them.
Current procedures for accessing PrEP include long waiting times at facilities, as well as seeing multiple people including the counsellors and medics, which increases the risks of stigma for clients.
Prof Ngure has echoed the IAS presenters, saying there is a need to ensure that the PrEP manufacture and distribution process should be tailored to meet the needs of users, including the reduction of stigma at the point of collection.
“Next-generation PrEP products should be long-acting, discreet, affordable, safe and delivered within a client-friendly environment. This will encourage more people to use them and reduce the stigma associated with their use,” he said.
