Narratives from women using the dapivirine vaginal ring in an open label extension study by Kalendri Naidoo.

Abstract

In sub-Saharan Africa, women and girls represented 63% of new Human Immunodeficiency Virus (HIV) infections in 2020. Adolescent girls and young women (AGYW) aged 15–24 years are twice as likely to be living with HIV as compared to young men. Therefore, efforts to develop and roll out safe, effective and acceptable HIV prevention products for women, are continuing. An important example of a female-initiated HIV prevention strategy is the dapivirine vaginal ring which showed a 27% reduction in HIV-1 incidence in the Microbicides Trials Network (MTN)-020/A Study to Prevent Infection with a Ring for Extended Use (ASPIRE) study and by 31% in the International Partnership for Microbicides (IPM)-027 The Ring study. The dapivirine vaginal ring was subsequently tested for safety and adherence in the Open Label Extension (OLE), MTN-025/HIV Open-label Prevention Extension (HOPE) study. The MTN-032/Adherence in HOPE and ASPIRE (AHA) study was a two-phase exploratory sub-study of the ASPIRE (AHA part 1, after ASPIRE and before HOPE study initiation) and HOPE (AHA part 2, after HOPE was completed) studies which utilised single qualitative indepth interviews (IDIs) to explore social conditions and issues related to participation around the use of the dapivirine vaginal ring as well as suitable approaches to market the study product. I report on the narratives from women participating in the AHA study (Part 2) within the context of known safety, partial product efficacy and choice, focusing on what motivated women to join the HOPE OLE study, women’s understanding of the vaginal rings’ efficacy, how they understood it to work in their bodies to prevent HIV and barriers and motivators to vaginal ring adherence.