Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2022 Aug 1;90(4):418-424.
doi: 10.1097/QAI.0000000000002990.

Patterns of Adherence to a Dapivirine Vaginal Ring for HIV-1 Prevention Among South African Women in a Phase III Randomized Controlled Trial

Erica N Browne  1 , Elizabeth R Brown  2   3 , Thesla Palanee-Phillips  4   5 , Krishnaveni Reddy  4 , Logashvari Naidoo  6 , Nitesha Jeenarain  6 , Gonasagrie Nair  7 , Marla J Husnik  2 , Devika Singh  8 , Rachel Scheckter  9 , Lydia Soto-Torres  10 , Jared M Baeten  11   12 , Ariane van der Straten  13   14 ; MTN-020/ASPIRE Study Team
Affiliations
Clinical Trial

Patterns of Adherence to a Dapivirine Vaginal Ring for HIV-1 Prevention Among South African Women in a Phase III Randomized Controlled Trial

Erica N Browne et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Persistent use of HIV prevention methods can be a challenge, particularly for some younger women. The long-acting, discreet, woman-centric dapivirine vaginal ring offers promise as a prevention method with less user burden, which could support continued use. We assessed dapivirine vaginal ring use to understand adherence patterns and identify characteristics influencing patterns.

Setting: Participants enrolled in South Africa in the MTN-020/ASPIRE randomized placebo-controlled trial.

Methods: We used group-based trajectory modeling to identify clusters of participants with similar longitudinal patterns of adherence in the last year of participation and potential predictors of group membership. Women with at least 1 year of follow-up were included (n = 626).

Results: Five adherence patterns were identified: (1) consistently high, 34%, (2) consistently moderate, 34%, (3) consistently low, 16%, (4) decreasing, 9%, and (5) increasing, 7%. Women younger than 22 years [adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI): 1.0 to 3.0], using an intrauterine device (AOR 3.3, 95% CI: 1.4 to 7.8) or oral contraceptives (AOR 3.9, 95% CI: 1.7 to 8.9), experiencing menses (AOR 1.8, 95% CI: 1.1 to 3.0), and who reported inconsistent condom use (AOR 1.8, 95% CI: 1.0 to 3.3) were more likely to be classified as consistently low compared to consistently high (referent).

Conclusions: Most South African women successfully persisted with a moderate or high level of use. Encouraging ring replacement with completion of menses may help to decrease concerns about hygiene and improve persistence. Associations between contraception and persistent low adherence suggest efforts may be needed to ensure contraceptive method choice does not interfere with ring use.

Trial registration: ClinicalTrials.gov NCT01617096.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Estimated group-based trajectories of dapivirine (DPV) vaginal ring adherence during the last year of follow-up among women enrolled in South Africa, with 95% confidence intervals (N=626).
See this image and copyright information in PMC

References

    1. Celum CL, Delany-Moretlwe S, Baeten JM, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(Suppl 4):e25298. - PMC - PubMed
    1. Beksinska ME, Smit JA, Mantell JE. Progress and challenges to male and female condom use in South Africa. Sex Health. 2012;9(1):51–58. - PMC - PubMed
    1. O’Leary A Women and HIV in the twenty-first century: how can we reach the UN 2030 goal? AIDS Educ Prev. 2018;30(3):213–224. - PubMed
    1. Sidebottom D, Ekstrom AM, Stromdahl S. A systematic review of adherence to oral pre-exposure prophylaxis for HIV - how can we improve uptake and adherence? BMC Infect Dis. 2018;18(1):581. - PMC - PubMed
    1. Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–2132. - PMC - PubMed

Publication types

Associated data