Risk Compensation in the Context of Sexually Transmitted Infections in Women Using the Dapivirine Vaginal Ring in Africa: A Scoping Review.

BACKGROUND

Sexually transmitted infections (STIs) remain a critical public health challenge globally, with Africa facing the highest incidence and mortality rates. The Dapivirine Vaginal Ring (DVR) is a discreet HIV prevention tool for women but does not protect against other non-HIV STIs. Like any other HIV biomedical prevention tool, DVR might lead to increased STI prevalence. Thus, this scoping review assessed the prevalence of STIs and the sociocultural, economic, and demographic factors influencing STI risk among African women using DVR in Africa. The review also examined current policies and interventions to reduce STI risk.

METHOD: We searched electronic databases such as the Ovid platform, MEDLINE, Embase, Global Health, CINAHL, Web of Science, Cochrane Library databases, Social Sciences Citation Index, and Gray literature from January 2014 to July 2024. The Rayyan tool was used to screen the title and abstract, whereas DistillerSR Version 2 was used for the full text screening. The qualitative data were analyzed for themes using QDA Miner Lite, while the numeric data was analyzed using the Microsoft Excel Package. This scoping review followed the PRISMA-ScR guidelines.

RESULT: Out of 1,247 papers, 11 were selected. The overall end-point prevalence of any STI was 33.42%, with specific rates for chlamydia (18.34%), Neisseria gonorrhoeae (8.56%), Trichomonas vaginalis (9.38%), and syphilis (0.90%). Sociocultural, economic, and demographic factors, including poverty, patriarchy, location, knowledge, and age, were found to influence STI risk among women using DVR. Suggested policies include routine STI screening, education, targeted interventions, and partner treatment frameworks to effectively control STIs.

CONCLUSION

Our findings reveal no evidence of risk compensation with DVR use. Holistic sexual health services are needed to support the use of DVR and prevent other STIs. Further research on biomedical tools that prevent both HIV and other STIs is crucial to address this gap.