Skip to main content
SpringerLink
Log in

Efficacy and Action of the Dapivirine Vaginal Ring as Understood by Women Participating in an Open Label Extension Study

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

The concept of efficacy, and how HIV prevention products biologically work can be complex. We report on women’s interpretation of efficacy of the dapivirine vaginal ring and how they understood it to work to prevent HIV during the MTN-025/HOPE study through data collected from individual in-depth interviews. Ten women at each of the 6 HOPE research sites in Lilongwe, Malawi; Durban (2 sites) and Johannesburg, South Africa; Kampala, Uganda; and Chitungwiza, Zimbabwe, were enrolled (n = 60). Despite its partial efficacy, women trusted the ring to prevent HIV even when condoms were not used. The action of the ring was understood by most, however, there were misunderstandings around how quickly or slowly protection was offered when the ring was inserted or removed. Counselling sessions adapted to address partial efficacy, a multi-layered HIV prevention plan and how study products work could alleviate inconsistent adherence and diminished protection and further support women in receiving the best protection from their HIV prevention product of choice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data will not be available to the public. If an individual is interested in exploring the data, they should contact the lead author.

Code availability

N/A.

References

  1. UNAIDS. Fact sheet 2021, preliminary UNAIDS 2021 epidemiological estimates. Available at: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf.

  2. Mash R, Mash B, de Villiers P. ‘Why don’t you just use a condom?’: Understanding the motivational tensions in the minds of South African women. Afr J Prim Health Care Fam Med. 2010; 2(1), Art. #79, 4 pages.

  3. Hlongwa M, Peltzer K, Hlongwana K. Risky sexual behaviours among women of reproductive age in a high HIV burdened township in KwaZulu-Natal, South Africa. BMC Infect Dis. 2020; 20, 563.

  4. Baxter C, Abdool Karim S. Combination HIV prevention options for young women in Africa. Afr J AIDS Res. 2016;15:2,109–21.

    Article  Google Scholar 

  5. Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–32.

    Article  CAS  Google Scholar 

  6. Nel A, van Niekerk N, Kapiga S, et al. Safety and efficacy of a dapivirine vaginal ring for HIV prevention in women. N Engl J Med. 2016;375:2133–43.

    Article  CAS  Google Scholar 

  7. Baeten JM, Palanee-Phillips T, Mgodi NM, et al. Safety, uptake, and use of a dapivirine vaginal ring for HIV-1 prevention in African women (HOPE): an open-label, extension study. Lancet HIV. 2021;8(2):e87–95.

    Article  Google Scholar 

  8. Nel A, van Niekerk N, Van Baelen B, et al. Safety, adherence, and HIV-1 seroconversion among women using the dapivirine vaginal ring (DREAM): an open-label, extension study. Lancet HIV. 2021 Feb;8(2):e77–86.

    Article  Google Scholar 

  9. Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring: March 2021. Geneva: World Health Organization; 2021.

  10. Gwarisa M. #BREAKING: Dapivirine, Vaginal Ring Approved For Use In Zimbabwe. 2021; https://healthtimes.co.zw/2021/07/14/breaking-dapivirine-vaginal-ring-approved-for-use-in-zimbabwe/. Accessed July 27, 2021.

  11. Fokazi S. More HIV prevention options for SA women as vaginal ring is approved. 2022; https://www.timeslive.co.za/news/south-africa/2022-03-16-more-hiv-prevention-options-for-sa-women-as-vaginal-ring-approved/. Accessed March 25, 2022.

  12. Naidoo K, Mansoor LE, Katz AWK, et al. Qualitative Perceptions of dapivirine VR adherence and drug level feedback following an open-label extension trial. J Acquir Immune Defic Syndr. 2021;86(4):e90–6.

    Article  Google Scholar 

  13. Montgomery ET, Katz AWK, Duby Z, et al. Men’s Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe. AIDS Behav. 2021 Jun;25(6):1890–900.

    Article  Google Scholar 

  14. Van der Straten A, Montgomery ET, Musara P, et al. Disclosure of pharmacokinetic drug results to understand nonadherence. AIDS. 2015;29(16):2161–71.

    Article  Google Scholar 

  15. Woodsong C, MacQueen K, Amico KR, et al. Microbicide clinical trial adherence: insights for introduction. J Int AIDS Soc. 2013;16(1):18505.

    Article  Google Scholar 

  16. Geary CW, Bukusi EA. Women and ARV-based prevention: opportunities and challenges. J Int AIDS Soc. 2014;17(3Suppl 2):19419.

    Google Scholar 

  17. Balán IC, Giguere R, Lentz C, et al. Client-centered adherence counseling with adherence measurement feedback to support use of the dapivirine ring in MTN-025 (The HOPE Study). AIDS Behav. 2021;25(2):447–58.

    Article  Google Scholar 

  18. Celum CL, Delany-Moretlwe S, Baeten JM, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(Suppl 4(Suppl Suppl 4):e25298.

    Google Scholar 

  19. Eakle R, Weatherburn P, Bourne A. Understanding user perspectives of and preferences for oral PrEP for HIV prevention in the context of intervention scale-up: a synthesis of evidence from sub-Saharan Africa. J Int AIDS Soc. 2019;22(Suppl 4(Suppl Suppl 4):e25306.

    Google Scholar 

  20. Eaton LA, Kalichman S. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep. 2007;4(4):165–72.

    Article  Google Scholar 

  21. Rojas Castro D, Delabre RM, Molina JM. Give PrEP a chance: moving on from the “risk compensation” concept. J Int AIDS Soc. 2019;22(Suppl Suppl 6):e25351. Suppl 6(.

    Google Scholar 

  22. Ortblad KF, Stalter RM, Bukusi EA, et al. No Evidence of Sexual Risk Compensation Following PrEP Initiation Among Heterosexual HIV Serodiscordant Couples in Kenya and Uganda. AIDS Behav. 2020 May;24(5):1365–75.

    Article  Google Scholar 

  23. Kusemererwa S, Abaasa A, Kabarambi A, Onyango M, Mugisha JO. Assessment of risk compensation following use of the dapivirine vaginal ring in southwestern Uganda. Sex Transm Infect. 2022;98(1):32–7.

    Article  Google Scholar 

  24. Hodges-Mameletzis I, Fonner VA, Dalal S, Mugo N, Msimanga-Radebe B, Baggaley R. Pre-Exposure Prophylaxis for HIV Prevention in Women: Current Status and Future Directions. Drugs. 2019;79(12):1263–76.

    Article  CAS  Google Scholar 

  25. Montgomery ET, van der Straten A, Stadler J, et al. Male Partner Influence on Women’s HIV Prevention Trial Participation and Use of Pre-exposure Prophylaxis: the Importance of “Understanding”. AIDS Behav. 2015;19(5):784–93.

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful to all the women that participated in this study, the study staff that implemented this study and the RTI International team for their guidance and expertise with data analysis. We also acknowledge the MTN leadership, MTN 032 management team and FHI360 for protocol development and implementation.

Author information

Author notes

  1. Naidoo Sarita

    Present address: The Aurum Institute, Johannesburg, South Africa

Authors and Affiliations

  1. Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu- Natal, Durban, South Africa

    Kalendri Naidoo & Mansoor E. Leila

  2. Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America

    Montgomery Elizabeth T. & Ariana WK. Katz

  3. Global Health Population and Nutrition, FHI 360, Durham, NC, United States of America

    Garcia Morgan

  4. Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Reddy Krishnaveni

  5. Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America

    Soto-Torres Lydia

  6. HIV and Other Infectious Diseases Research Unit (HIDRU), South African Medical Research Council, Durban, South Africa

    Naidoo Sarita

  7. Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd Floor), 719 Umbilo Road, Private Bag X7, 4013, Congella, Durban, South Africa

    Kalendri Naidoo

Authors
  1. Kalendri Naidoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Montgomery Elizabeth T.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ariana WK. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Garcia Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reddy Krishnaveni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Soto-Torres Lydia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naidoo Sarita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mansoor E. Leila
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Kalendri Naidoo was involved in the study implementation at the study site, data collection, data interpretation, data coding and analysis and writing this article. Elizabeth T. Montgomery was involved in the study design, overall study implementation, data interpretation and article review. Sarita Naidoo was involved in the study design, overall study implementation and article review. Ariana W.K. Katz was involved in the study design, oversaw study implementation, data coding and analysis, data interpretation and article review. Morgan Garcia and Lydia Soto-Torres were involved with overall study implementation and article review. Leila E. Mansoor and Krishnaveni Reddy were involved with study implementation at the study site, data collection and article review.

Corresponding author

Correspondence to Kalendri Naidoo.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Source of funding

The MTN-032/Assessment of ASPIRE and HOPE Adherence (AHA) study was designed and implemented by the Microbicide Trials Network (MTN). The MTN is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the United States (US) National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The vaginal rings used in this study were supplied by the International Partnership for Microbicides (IPM).

Ethics approval

The MTN 032 study protocol was approved by the Institutional Review Boards at RTI International, and at each study site and regulated by the U.S. National Institutes of Health and the Microbicide Trials Network.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

All participants were informed that any publication of this study will not use their name or identify them personal.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naidoo, K., T., M.E., Katz, A.W. et al. Efficacy and Action of the Dapivirine Vaginal Ring as Understood by Women Participating in an Open Label Extension Study. AIDS Behav 27, 75–81 (2023). https://doi.org/10.1007/s10461-022-03745-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-022-03745-y

Keywords

Search

Navigation