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[KAMPALA]  Two large phase III trials in Sub-Saharan Africa have shown promise of protecting women from HIV infection by 27-31 per cent.
The two trials, A Study to Prevent Infection with a Ring for External Use (ASPIRE) and The Ring study, aim to identify complementary HIV prevention strategies for women.
ASPIRE and the Ring study have shown that a monthly vaginal ring having the antiretroviral drug, dapivirine, can safely help avert HIV-1 infection in women, it was announced this week (22 February) at the annual Conference on Retroviruses and Opportunistic Infections in Boston, Massachusetts in the United States.

“It is a big step towards self-initiated HIV prevention among women.”

Anatoli Kamali, MRC/UVRI Uganda Research Unit on AIDS

“I am excited. It is the first time we get something for women,” says Clemencia Nakabiito, a principal investigator with the Microbicide Trials Network (MTN) in Uganda conducting ASPIRE, noting that the ring could reduce viral load in the country.
Anatoli Kamali, deputy director of the MRC/UVRI Uganda Research Unit on AIDS, who is involved in the Ring study in Uganda, adds:  “It is a big step towards self-initiated HIV prevention among women.”
ASPIRE showed that the monthly dapivirine ring safely reduced HIV infection overall by 27 per cent compared to a placebo, whereas The Ring study reduced HIV risk by 31 per cent overall, and by 37 per cent among participants older than 21 years old.
ASPIRE was led by the US National Institutes of Health-funded MTN while the Ring study was directed by the nonprofit International Partnership for Microbicides (IPM).
But both trials show that an uphill task remains in finding a solution for young people.
For young women ages 18-21 years old, HIV risk reduced by 15 per cent in the Ring study, but there was no protection in ASPIRE.
Kenneth Mwehonge, programmes officer of the Uganda-based Coalition for Health Promotion and Social Development, tells SciDev.Net: “Young women and youth have the highest infection rates. It is a disappointment because it leaves our young women with no protection.”
ASPIRE enrolled 2,629 HIV-negative women ages 18 to 45 years old at 15 clinical research sites in Malawi, South Africa, Uganda and Zimbabwe, whereas the Ring study enrolled 1,959 women in South Africa and Uganda.
Both trials started in 2012 but although ASPIRE ended in 2015, the  continuing the Ring study is reporting results early, following a recommendation of its independent data and safety monitoring board that the study proceed to final analysis, according to a statement issued by IPM this week (22 February)
As with previous trials involving other HIV prevention methods, adherence to the prescribed use appeared higher among older women, which might explain higher levels of efficacy in these age groups, says a statement released this week (22 February) by AVAC, an advocacy group for HIV prevention worldwide. “Adherence was about 80 per cent generally, more than we ever had in any ring study,” says Flavia Matovu, a researcher at Uganda-based Makerere University and a principal investigator involved in ASPIRE, noting that young women are less likely to take things seriously.
According to Matovu, further studies are under way to understand HIV prevention among young women, especially the reasons for not adhering to the rings.
“It is not easy to abstain or use a condom. A tool that can be used by young women is very crucial,” Matovu adds.

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.

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