My experience with HIV/AIDS Dapivirine Ring

The Dapivirine vaginal ring used in an HIV prevention trials. (AFP)

Manufacturers of the HIV Dapirivine Vaginal Ring (DPV-VR) believe the device could a game-changer in the fight against HIV/AIDS.

The Dapivirine vaginal ring used in HIV prevention trials. (AFP)

Recently, the World Health Organization, (WHO) added the ring to WHO’s list of prequalified medicines. The action confirms that the device ring meets global standards for quality, safety and efficacy. This will help in guiding national and global procurement decisions, pending country regulatory approval for its use.

A woman inserts the ring in a way that allows the device to sit in the woman’s cervix. The ring then begins releasing antiretroviral drugs over a 28 day period. The ARVs create an atmosphere where HIV cannot thrive. One then replaces it after 28 days as it has already released all the contents of the drug.

Currently, women who do not have HIV but are at high risk of contracting the virus use Pre-exposure prophylaxis (PrEP) pills to prevent them from acquiring HIV/AIDS. However, PrEP is most effective when taken daily as prescribed. The DPV-VR offers a safe, affordable, convenient and discreet option for women the as no one has to know when a woman above the age of 18 decides to use it.

DPV-VR trials were conducted during the past year in South Africa, Uganda, Zimbabwe and Malawi.

27-year-old Akhona Gxarhisa of Cape Town was one of several women taking part.

“Being part of the women who saved other women, I feel almost like a hero”, says Gxarhisa.

For about five years, Akhona had the vaginal ring on, without any complications. However, her then partner had an issue with her being part of the trials.

Akhona Gxarhisa, Participant DVR-VR Trials

“For me, my partner didn’t feel it but as soon as I told him that I had this thing inserted inside of me. He started feeling it, out of nowhere,” she says. “That goes to show the lack of knowledge in the male population about this vital ring that has been added on to the list of options for young girls and women, Akhona shared the experience of some of the other participants…” The other lady I remember, her partner asked her to take it out and she refused to take it out, so the partner had to dump her.”

Clearly, a conversation needs to start on bringing men on board, just for them to understand the importance of DPV-VR, this needs to be done by various organizations championing the fight against HIV/AIDS.

“As soon as the ring is distributed in South Africa, I just hope that the government, if they’ll be selling it, I just hope that they’ll be selling it at a reasonable price,” Akhona said.

Sentiments echoed by Dr. Zeda Rosenberg, Founder and CEO of International Partnership for Microbicides (IPM), which developed the ring.

“Our intent is to make the ring available at the lowest possible cost and hopefully free,” Dr. Rosenberg said.

IPM has thus far conducted tests in two very large phase 3 trials to determine its safety, and the ring has been found to reduce the risk of HIV transmission by a minimum 35%, among the population of women who actually used the ring, as there are those who despite being part of the trials did not actually use DPV-VR.

“The reason many women don’t use experimental drugs in clinical trials is that every month we are telling women and in fact at the beginning of the studies, we tell women, we don’t know how effective the product is that you’re going to be using,’ says Dr. Rosenberg. “We know that it’s safe in small numbers of women but we don’t know how safe it is in large numbers of women and especially women who are young and haven’t had children yet, are very worried about a potential product affecting pregnancy and ability to get pregnant in future. Therefore, a lot of young women don’t even want to use the product.”

IPM now has the responsibility of getting the ring approved in other countries.

Dr. Zeda Rosenberg, Founder and CEO IPM

“Next steps obviously are to have the African countries review all the data and decide, every country decides for itself whether or not the ring should be appropriate for their populations.”

She said amidst hopes that many African countries will acquire the rings.

IPM is now actively applying for the ring to be reviewed by countries in Sub-Saharan Africa, where women face persistently high HIV risk. Initial submissions are planned for Eswatini, Kenya, Lesotho, Malawi, Rwanda, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.

Kenya is rated 3rd in the burden of HIV globally. According to LVCT Health Kenya, 33% of new infections are adolescent girls and young women, this is why the ring is so important to them.

“We know adolescent girls and young women are struggling to take PrEP because of many issues. It requires you to take a dose daily, that alone they’re saying they’ve been struggling, and then there are also some of them who faced violence as they take PrEP from their intimate partners, DPV-VR comes in as a woman-controlled tool,” Said Patriciah Jeckonia a Senior Technical Advisor, Policy and Prevention LVCT Health Kenya.

And so the wait starts or continues, to what could be the turning point in the fight against HIV/AIDS particularly in Africa that has lasted for years.