PrEP vaginal ring ‘as effective’ as PrEP pills in Zimbabwe study

Encouraging data on the PrEP vaginal ring from Zimbabwe shows the importance of giving women a choice when it comes to HIV prevention. 

What is the research about? 

How effective the dapivirine vaginal ring is at preventing HIV, compared to oral PrEP. And how popular it is among young women (ages 18 to 25) in Zimbabwe who were offered it as an alternative to daily PrEP pills.  

Young women from eight districts, including young women who sell sex, were asked to take part in a demonstration study comparing the two PrEP methods. All were HIV-negative at the start of the study. 

Why is this research important? 

Heterosexual women in sub-Saharan Africa are more at risk of HIV than heterosexual men, particularly adolescent girls and young women. But they often struggle to negotiate condom use during sex.  

PrEP is a way to prevent HIV transmission that women can be in control of. It is still not widely available in sub-Saharan Africa, but where it is offered it normally comes in pill form. PrEP pills must be taken every day. But remembering (or being able) to take a daily pill, and the fact that PrEP pills are associated with a similar stigma to HIV medication, means not everyone who can access PrEP wants to use it, or they only use it for a short while.  

The dapivirine ring provides an alternative to PrEP pills. The ring goes inside the vagina and slowly releases the antiretroviral medication dapivirine. Women can change the ring themselves and only need to do this once a month.  

What did they find out? 

Just over 1,000 young women chose the ring over PrEP pills. It was particularly popular in rural areas, where almost all study participants chose it instead of oral PrEP. Just over half of urban participants also chose the ring.  

Young women who chose the ring were followed for six months and tested for HIV every month. Of these, 86% were still using the ring in the second month. This is a higher adherence rate to oral PrEP, which only 76% of women continued using during the second month. In month four, 64% of young women were still using the ring, compared to 59% of young women who had opted for PrEP pills.  

Eight young women who opted for the ring got HIV during the study (0.78%). This is a similar infection rate to people who used oral PrEP in other studies.  

Six women tested HIV positive after the first month of using the ring. It is likely that some or all of these women got HIV just before the study started, but this had not shown up in an initial HIV test. Other women who got HIV during the study said they had removed the ring and had unprotected sex. 

Most young women who used the ring said it was easy to use. 

What does this mean for HIV services? 

These findings suggest that some women may prefer a PrEP vaginal ring over PrEP pills. And if used correctly, a vaginal ring will be an effective way to prevent HIV. 

Zimbabwe is about to start bigger implementation research studies in public facilities, with wider scale-up planned after that. Cost will be a big consideration as how to make the ring widely available. But if the ring is scaled-up in Zimbabwe, and hopefully elsewhere, women will finally have more ways to protect themselves from HIV.