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.

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 with 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 6 m each (February 2019-September 2021). Participants rated overall product acceptability (1, dislike very much to 5, like very much) after 3 m and 6 m, and product characteristics/use attributes after 3 m. 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 3 m and overall acceptability after 6 m (χ 2 ).

RESULTSOVERALL,: 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.