A daily pill, a monthly vaginal ring or an injection every two months: These were the prevention options available to young women on the uChoose study to help them prevent HIV infection. Brady Hooley, from the Desmond Tutu HIV Foundation, presented the findings of this study.
There are many new prevention tools becoming available to HIV-negative people to protect them from infection. A daily pill, PrEP (Pre Exposure Prophylaxis) creates a barrier around cells that stops HIV. The vaginal ring is a soft plastic device that is inserted in the vagina where it slowly releases a drug for the period of a month to prevent HIV infection. Longer-lasting than either of these is the injectable which is effective for two months. Finding out which methods are best for each person will guide how these tools are distributed as they are released on the market.
The study examined the preferences of around 130 sexually active women in Masiphumelele between the ages of 15-19. Every participant was tested on the vaginal ring and then had the option to chose between the oral pill or the injection after 16 weeks. The trial lasted 32 weeks.
At the start of the study, nearly a third of the participants had not used any sort of contraception during intercourse for the past two months, putting these women at risk of HIV infection. Additionally, the levels of STIs at the start of the study were very high: just over half the cohort. An extra 15% had bacterial vaginosis (BV): an overgrowth of bacteria normally present in the vagina. Whilst BV is not necessarily an STI, it puts women at greater risk of HIV infection and other STIs.
The bimonthly injectable contraceptive appeared to be the preferred prevention tool by participants, which also had the highest adherence. Whereas the daily pill had poor adherence and adolescents can suffer from pill fatigue. Whilst further study is required to make conclusive statements, thus far the trend seems to be that prevention options that are taken less-frequently are preferred.
The vaginal ring was more popular than the pill and had the most reliable adherence, partly due to the combination of a large time-interval between doses and the convenience of changing the ring without needing to visit a clinic.
These findings will help inform policy and future research for rolling out PrEP products. Rollout strategies need this sort of evidence-based direction to create the most-effective prevention campaigns.
This research came from the Desmond Tutu HIV Foundation research meeting where Dr Katherine Gill and Brady Hooley presented their research. Gill spoke on the results of the Plus Pills study which examined how PrEP might be received in South African adolescents. Hooley summarised the findings from the uChoose study which examined women’s preference for different HIV prevention tools.
Written by Caroline Reid