Today is HIV Vaccine Awareness Day. A vaccine could most certainly eliminate new HIV infections; lead to epidemic control and perhaps even eradication. Though there are promising vaccines in the research pipeline, none are available yet.
Today is also an opportunity to reflect upon the gains made in HIV prevention beyond HIV vaccines. One major advancement worth celebrating is the newly developed and soon-to-be rolled-out dapivirine vaginal ring.
The World Health Organization in January recommended that the DPV-VR be offered as an additional HIV prevention option for women at substantial risk of HIV. This comes after the ring received a positive scientific opinion from the European Medicines Agency and prequalification from the WHO, which most African regulatory agencies consider when reviewing new products.
The product developer, the International Partnership for Microbicides, has submitted for regulatory approval in 10 African counties for early rollout, of which Kenya is one.
The DPV-VR is a silicone ring that is inserted into the vagina for monthly protection against HIV by slowly releasing the antiretroviral drug dapivirine. It is the first localised, long-acting HIV prevention product and, importantly, self-initiated by its user.
The ring is appreciated for its discreet nature, ease of use, good safety profile and minimal side effects. Most notably, it offers an option for those who do not or cannot take a daily pill or use a condom for HIV prevention. The ring could be a game-changer.
Other rings in early stage development include a multi-purpose combination of an ARV and a hormonal contraception to protect women against HIV while also preventing unintended pregnancies. Another ring also advancing through the research pipeline could be used for an extended three months at a time to prevent HIV. And there is a long-acting injectable and a monthly pill among other novel prevention methods on the horizon.
While a new HIV prevention option is great news, there are lessons to be learnt from oral PrEP, the daily HIV prevention pill that was approved for use in Kenya in 2015. Oral PrEP still has minimal uptake among young women and this raises concerns about the programmatic, structural and cultural barriers for the uptake of the DPV-VR:
Where and how will women obtain the DPV-VR? Who will teach them how to use it? Who will train the providers? Who will procure the drugs and accompanying tests? Will it be free? Will it be rolled out for priority groups first? Will the age of consent be lowered for adolescents at substantial risk of acquiring HIV? Will existing policies and guidelines create room for new product introduction? Is Kenya’s HIV establishment ready with the answers?
While it's exciting and critical to move ahead in planning for introduction, it’s as important to address these concerns and questions. Kenya must update its policies, guidelines and HIV prevention programming to create a soft-landing for new products such as the ring and the other HIV prevention methods right behind it. The government should also make the ring free and easy to access at sexual and reproductive health facilities, youth-friendly centres and drop-in centres where most women prefer to get their reproductive health-related services.
Women have different needs at different times of their lives. It’s important to provide full information and the opportunity to choose from a range of HIV prevention methods and not to assume all women will want the ring or oral PrEP or condoms or any future products. Like contraception, the more choices that are offered, the more women will be protected.
The prompt escalation of the DPV-VR across the various regulatory channels has seen women throughout sub-Saharan Africa become excited as the ring gets closer. Let’s not repeat the mistakes of oral PrEP rollout and prepare our systems for ring delivery now. The dapivirine ring will provide more prevention options, while HIV vaccine development progresses.
Women’s HIV prevention advocate with NEPHAK