Background
The Dapivirine ring (DVR) is effective for HIV prevention among women at risk for HIV, and an alternative when other biomedical options may not be preferred or feasible. In the SEARCH Dynamic Choice Prevention (DCP) studies, participants at risk for HIV could choose between oral PrEP, PEP, CAB-LA, and the DVR. We describe characteristics of ring users, reasons for choosing the DVR, and adherence patterns in the first 3 months of ring use.
Methods
The SEARCH DCP intervention offers choice of biomedical prevention options with flexibility to switch between options over time guided by changing HIV risk and preference. The DVR was added as an option in 2 ongoing studies in rural Uganda and Kenya1) oral PrEP, PEP, CAB LA, DVR (NCT 05549726) and 2) oral PrEP, PEP, DVR (NCT 04810650). Participants were seen in the clinic at DVR initiation and every 12 weeks during follow-up, with HIV testing, and monthly reminder phone calls. Participants had the option to return to the clinic monthly for ring insertion until comfortable with self-care.
Results
Of 1560 women in the intervention arms of the two studies, 34 (2%) chose and used the Dapivirine ring during follow-up. 21(62%) were from Uganda, and 7 (21%) were aged 15-24. Prior to selecting the ring, 18 (53%) had ever used PrEP, 2 (6%) had ever used PEP, 6 (18%) had ever used CAB-LA, and 15 (44%) had never used any biomedical prevention option. At initiation, 21 (62%) chose the DVR due to experienced or anticipated pill burden, 8 (23%) initiated the ring because it is discrete, 4 (12%) preferred CAB-LA but were ineligible, and 1(3%) chose the ring because they would forget to take pills. Following the baseline visit, 30/34(88%) women self-inserted the ring at week 4. The remaining 5 (14%) had the ring inserted by a health care provider. Of 25 who reached at least 3 months since ring initiation, 21 (84%) changed their rings on schedule, 4 discontinued rings due to menorrhagia (1), change in risk (1), or travel outside the community (2).
Conclusions
Among women offered prevention options in a Dynamic Choice model that included oral PrEP, PEP, and CAB LA, adding the Dapivirine Ring as an option was feasible and a preferred option in 2% of women to date. The Ring provided an alternative to some women who had not chosen any of the other biomedical prevention options previously offered.