The South African Health Products Regulatory Authority recently approved the use of the monthly dapivirine vaginal ring for women 18 years and older to reduce the risk of HIV infection. Spotlight looks at the evidence for the ring’s efficacy and asks what plans there are for making it available to women in South Africa.
) suggests efficacy in real-world use is better than in the two phase III trials, most likely due to better adherence. Even so, efficacy appears to be lower than that for oral PrEP.
Palanee-Phillips says the ring offers women a discreet way to reduce their HIV risk when they cannot or choose not to use higher efficacy methods like daily prevention pills. “Open-label studies among African women, including women here in South Africa, have shown high acceptability of the ring as well as high adherence . Encouraging findings from a study called Reach, among younger girls and women aged 16-21 years, also show that a monthly ring is a feasible option for younger women in Africa who cannot or choose not to use daily oral PrEP,” she says.that both the ring and prevention pills are effective.
“Implementation policy and guidelines are required for public healthcare facilities. They will have to be drafted and presented to the National Health Council,” Foster Mohale, the department’s spokesperson, tells“Procurement of the commodity will require projected quantity, budgets, supply chain in accordance with public procurement requirements.
When asked if the Department will roll the ring out only through public sector clinics or through other channels, Mohale tellsthat there are no immediate details and plans for implementation at this stage. However, these will be considered once there is approval and resources for implementation are available.International Partnership for Microbicides , says that as a non-profit, the goal is for the ring to be publicly funded and provided to women at low or no cost.
According to Mullick, there has been a great deal of work done to engage communities around the ring, particularly in communities where ring clinical trials and other research, such as qualitative studies and market research to inform demand creation strategies, took place.
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