By Tusiime Apollo
Authorities in Uganda have hailed the use of the newly approved Dapivirine Vaginal Ring (DPV-VR) as a tool that will significantly change the landscape in the fight against HIV/AIDS in the country.
The DPV-VR is a silicone ring which women insert in their private parts, and has an antiviral agent that is able to prevent HIV infection by releasing the antiretroviral drug Dapivirine (NNRTI) from the ring into the vagina slowly over 28 days.
In November 2022, the Ministry of Health (MOH) approved use of the Dapivirine Vaginal Ring and long-acting injectable Cabotegravir (CAB-LA), as additional optional drugs for preventing HIV infections in Uganda. The move followed the World Health Organization’s (WHO) approval of the two drugs in January 2021.
Dr. Daniel Byamukama, the head of HIV prevention at Uganda AIDS Commission (UAC) said the Dapivirine ring and the injectable Cabotegravir have exceptional advantages to women in Uganda majorly due to unfavorable societal norms which often alienates women from using the available technologies. Currently, the HIV negative individuals rely on Pre-exposure prophylaxis (PrEP) where they take a pill on a daily basis to lower the risk of contracting HIV when exposed to the virus.
“The main treatment we have been giving is oral; the tablets which must be swallowed daily. But we discovered that the tablets have a challenge and women are not using these methods because of society norms as some women were being violated by husbands, and they needed discrete methods which they can use even when their husbands do not consent” Dr. Byamukama said in an interview with our reporter.
Dr. Byamukama says owing to their flexibility in use, the two new products fit well in the government’s new strategy which focuses on treatment-based remedies as opposed to post-exposure interventions.
Mr. Hasunira Richard the HIV/AIDS adviser at HEPS Uganda, says the DPV-VR is an important innovation in the fight against HIV infections because it is “a women-controlled tool” that will put HIV prevention in the hands of women. He says if all women vulnerable to HIV can embrace it, it will be a game changer in the fight against the virus.
“We have found a problem in adherence with ARV’s that people must be reminded to take a tablet everyday but when you buy a product that can be used for a month; that is a very big innovation.” He said.
Despite the tremendous success made in reduction of HIV prevalence in Uganda from 18 percent in 1990s to the current 5.5 percent, the prevalence among women remains at 7.2 percent, 4.2 percent among men and the prevalence among adolescents is for times bigger with girls bearing the highest brunt of new infections. According to the 2022 National HIV/AIDS Report from Uganda AIDS Commission, the country registered 54,000 new HIV/Aids infections, of which two-thirds were and girls bear the highest brunt of new infections.
Dr. Byamukama affirmed that societal norms which marginalize women are attributed to high rates of HIV prevalence in women. He noted that Men will also benefit from the newly approved drug -the monthly injection of Cabotegravir, which he said has been proven to be highly effective against HIV infections.
Beatrice Musenero a 29 year-old married woman who lives in Kalangala District one of the areas with high HIV/AIDS prevalence rates in Uganda said she has used PrEP for several years but adherence to the daily pill is problematic and she at times skips the schedule for reasons including fear of retribution from her husband.
“I have to conceal the pills from my husband and I cannot take them in his presence because he may think it I am taking ARV’s used by HIV patients. More so, some people do not want to associate with daily pills for fear of stigma. I think the ring which can be used for the whole month is a better option.” Musenero said.
Nakawunde Resty the Vice Chairperson for Kalangala District Local Government and Secretary for Women and Gender, said sensitization of the public is paramount ahead of the roll out of these new technologies in order to optimize the benefit from the new products. She however advised that the DPV-VR should be accessible to only women above 18 years and high-risk groups in order to avoid triggering laxity in young adolescents.
“We will embrace the ring if the concerns about quality and safety of the users have been addressed. It sounds to be a better option compared to pills or female condoms which can be easily forgotten or ignored” Nakawunde remarked.
Dr. Byamukama assured Ugandans that relevant bodies including the National Drug Authority have conducted all prerequisite measures to ensure quality and safety of the DPV-VR and the injectable Cabotegravir in preparation for introduction of these new drugs on local market by the end of the year 2023.
“We believe that the Dapivirine ring is beneficial and convenient for a woman because it is long-acting; one ring per month; so the woman doesn’t have to bother the husband looking for money or permission to to go to a health facility. Secondly, it is discrete; once it is inserted by yourself or a health worker, nobody will know that you have your method working for you” He said.
Hasunira however recommends that authorities should adequately sensitize the public on the risks associated with use of these new technologies but also empower health workers with capacity to unpack information about them since they will be in-charge of rolling out the new technologies to the public.
Hasunira notes that the DPV-VR is intended to reduce the risk of acquiring HIV during vaginal sex for women who are at substantial HIV risk as a complementary prevention approach in addition to other safer sex practices and therefore should not be misrepresented as a complete remedy to HIV infection. He also said authorities in Uganda should ensure that the drugs should also be available when needed in order to maximize the benefit from the new products.
The Ring Study demonstrated an HIV reduction of 35% among women using DPV-VR, and the ASPIRE study a 27% reduction in risk. Research is also under way to develop a vaginal ring that incorporates both birth contraception and HIV prevention.