The dapivirine vaginal ring will soon be available to women and young girls at limited pilot sites from June.  The South African Health Products Regulatory Authority (SAHPRA) approved its use by women ages 18 and older to reduce their HIV risk in March last year.

Health ministry spokesperson Foster Mohale says these pilot sites will be determined following consultations with the research partners and the Global Fund supported partners.

30 thousand vaginal rings on the way

Mohale says USAID will send South Africa over 30,000 dapivirine rings in May. But these will only be released for use after quality testing is completed. 

“Based on these projections the proposed date to commence with the implementation of the first consignment of donated dapivirine vaginal rings is 1 June 2023 (subject to the completion and compliance with the quality testing requirements),” says Mohale.

The dapivirine ring is made of a flexible silicone matrix. It contains the antiretroviral dapivirine. Once inserted in the vagina, dapivirine is released into the reproductive tract mucosa. It is a pre-exposure prophylaxis tool. The ring is left in for 28 days, after which it is replaced. 

Increases pool of preventative HIV measures

South African National Aids Council (SANAC) spokesperson, Nelson Dlamini says the dapivirine ring will increase the pool of prevention tools against HIV in the country.

“When someone tests negative but identifies as being at substantial risk of acquiring HIV, the recommendation is to offer them PrEP. PrEP is currently available as a daily oral pill. The dapivirine ring increases the pool of prevention tools against HIV,” says Dlamini.

Dlamini says the ring presents a lower risk of side effects. This is because the medicine enters the vaginal mucosa. It is also discreet and empowers women as they now have a female-controlled HIV prevention option which allows protection but does not require negotiation with a sexual partner.

“The benefit of the ring is that either a healthcare worker or the user can insert and remove it. As such access to dapivirine rings outside clinic settings, such as using pharmacies and community outreach models will be possible,” says Dlamini.

Pregnant and breastfeeding women miss out for now

Despite recent research revealing the dapivirine ring is safe to use in late pregnancy and while breastfeeding, Dlamini says SAHPRA has not approved it for use among pregnant and breastfeeding mothers. However, other PrEP options (oral PrEP) are available to them.  Once submitted, SAHPRA will review these new findings.

Dlamini says women and young girls in SA are more vulnerable to HIV infections due to inequalities caused by socio-economic factors. But he believes the ring will protect them if they can get access because it is safe and private.

“Most men do not want to use condoms, the voices of women saying no to unprotected sex are unheard. This may be the case in the blesser/blessee phenomenon. This where adolescent girls and young women depend on older men for financial and other support. They get infected because their blessers refuse condoms,” says Dlamini.

Mohale says the National Essential Medicines Listing Committee (NEMLC) reviewed the ring and recommended that its price be comparable to that of oral PrEP, Truvada which costs R600/month. The generic version costs R250  – Health-e News