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When given the option, adolescent girls and young women in Africa overwhelmingly opted to use either a drug-eluting vaginal ring or oral pre-exposure prophylaxis (PrEP) to protect against HIV infection, a researcher reported.

In the so-called REACH trial, 67% of adolescent girls and young women preferred to use the dapivirine vaginal ring, 31% were happy with oral PrEP, and just 2% weren't interested in either method, reported Kenneth Ngure, PhD, of the University of Washington in Seattle and Jomo Kenyatta University of Agriculture and Technology in Nairobi, Kenya.

In his presentation at the virtual Conference on Retroviruses and Opportunistic Infections (CROI), Ngure said the results of the crossover trial showed that individuals' adherence to either option played a role in their preferred mode of prevention.

Drug levels measured throughout the study, and during both the crossover and choice periods, indicated partial to high adherence for both methods, higher than seen in prior studies, Ngure said. "Adolescent girls and young women can make informed choices about HIV prevention products and use the products effectively with proper support."

The REACH trial, he told 番茄社区app at a press conference, did not follow the girls and women after the trial to determine if their use of the products continued and if they were successful in preventing HIV infection. He noted that in some cases, the products are still investigative and are not available in their locations. The trial was conducted among HIV-negative, non-pregnant participants in South Africa (60 subjects from Cape Town, 67 from Johannesburg), Uganda (60 from Kampala), and Zimbabwe (60 from Harare).

"New data from the REACH study presented at CROI reinforce the power of choice," Mitchell Warren, executive director of the global AIDS advocacy organization AVAC, said in a statement. "They show that when young women had access to and experience with two biomedical prevention options, almost all of them chose to continue using one of them -- and most of them actually chose to use the dapivirine vaginal ring."

The average age of the 247 adolescent girls and young women was 18 years, most were unmarried (87%), about 40% had been pregnant, and 38% had been on contraceptives for up to 70 days. About a third were still in school, three-fourths had at least a secondary school education, and one-fifth earned their own income.

After enrollment, participants were randomly assigned to two groups. For the first 6 months of the trial they utilized either the dapivirine vaginal ring or oral PrEP. During the next 6 month period, they switched methods of HIV prevention. After 1 year, the participants decided which method they wanted to select for the next 6 months of the 18-month trial. Ngure said 92% of the participants who started the trial reached the choice stage.

"At a time when regulatory agencies, policymakers and funders are reviewing inclusion of the dapivirine vaginal ring in HIV prevention programs and platforms, we must recognize that the most effective intervention is the one someone picks for themselves among an array of effective choices," said Warren. "REACH provides critical endorsement of both the ring and daily oral PrEP as two safe and effective options that many women need and can use, and of the need to provide multiple options from which women can choose."

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