Higher acceptability of the monthly dapivirine ring versus daily oral pre-exposure prophylaxis among adolescent girls and young women in sub-Saharan Africa in the REACH trial

Abstract

BACKGROUND: Oral pre-exposure prophylaxis (PrEP) is effective for HIV prevention, yet use has been inconsistent in adolescent girls and young women (AGYW). We compared PrEP to the dapivirine vaginal ring (ring) among AGYW in MTN-034 (REACH).

METHODS: We randomized 247 16-21-yr-old AGYW (South Africa, Uganda, Zimbabwe) to the sequence of using the ring and oral PrEP for 6m each (February 2019-September 2021). Participants rated overall product acceptability (1, dislike very much to 5, like very much) after 3m and 6m, and product characteristics/use attributes after 3m. We compared proportions of participants rating each product a "5" (binomial model with generalized estimating equations). We assessed associations between product characteristics/use attribute ratings at 3m and overall acceptability after 6m (Chi-square).

RESULTS: 65% and 41% of participants rated the ring versus PrEP a "5" (adjusted risk difference [aRD] 24%, 95% CI: 15%, 32%; p<0.001). For both products, high overall acceptability was associated with "excellent" self-rated adherence (ring, p< 0.001; PrEP, p = 0.03), product appearance (ring, p = 0.005; PrEP, p < 0.001), and ease of use (ring, p = 0.001; PrEP, p = 0.003). Not worrying about/or experiencing side effects were also associated with high acceptability of oral PREP.

CONCLUSIONS: The dapivirine ring was highly acceptable to substantially more individuals than oral PrEP, although a significant minority rated oral PrEP highly, even after using the ring. As has been found in the contraceptive field, offering AGYW a choice of PrEP products is likely to increase the use of any HIV prevention method in this vulnerable population.