A study conducted in five African countries found that when given a choice between different types of PrEP for HIV prevention, many women selected the dapivirine vaginal ring (DVR) – also known as the PrEP ring – although most chose daily oral PrEP, according to presenter Elizabeth Irungu of Jhpiego.
The CATALYST study, which is funded by PEPFAR and USAID through the MOSAIC project, aims to characterize an enhanced service delivery package for informed PrEP choice for women at public health sites in Kenya, Lesotho, South Africa, Uganda and Zimbabwe. Of 3,967 participants enrolled, 45% were aged 24 years or younger, 26% reported sex work, 9% were pregnant, 12% were breastfeeding and 68% had never taken PrEP.
At enrolment, 66% of participants chose oral PrEP, 30% chose the DVR and 4% chose no PrEP method. DVR uptake was 15% among pregnant women and 21% among breastfeeding women, where allowed.
In multivariable analysis among those who had choice, those having multiple sex partners in the past three months and those currently using a contraceptive method were more likely to choose the DVR instead of oral PrEP. Participants under the age of 25, new PrEP users and participants who were pregnant or breastfeeding were less likely to choose the DVR.
Participants who chose oral PrEP said they did so because it is easy to use (59%) and works well (32%); those who chose the DVR did so because it is easy to use (57%) and does not require swallowing pills (53%). According to the study team, women are taking advantage of PrEP choice. The results demonstrate moderate uptake of the DVR when offered within existing real-world PrEP programmes, and the findings will inform implementation of PrEP choice in the region.
The CATALYST study is ongoing and will soon produce evidence of how patterns of PrEP use change with choice of oral PrEP, the DVR and long-acting cabotegravir for HIV prevention.