•The ring can be used as pre-exposure prophylaxis when women lack access to or cannot use oral PrEP. It should be used in combination with other methods.
•The ring slowly releases the antiretroviral medicine Dapivirine over a period of 28 days, then must be replaced.
Image: Courtesy
Women at high risk of HIV infection can use the Dapivirine Ring as a new choice to prevent HIV.
The World Health Organization has recommended use of the ring as an additional prevention choice for women at substantial risk of HIV infection. It's recommended as part of a combined prevention approach.
It is intended for use by women aged 18 and older in developing countries.
It was not immediately known when or how it would be available; it is cost-effective but the cost is also not known.
The global health agency had included the ring - known as DPV-VR - on its prequalification list of medicines in November last year.
Approval followed a positive scientific opinion from the European Medicines Agency on the use of the DPV-VR in July last year.
The ring slowly releases Dapivirine for 28 days and is effective one day after insertion. After 28 days it should be replaced.
A study led by the International Partnership For Microbicides found that the ring reduced overall risk by 35 per cent among women using it.
It delivers medication directly at the site of potential infection and there is no significant absorption by the entire system. The device is well-tolerated, researchers said.
The ring can be used as pre-exposure prophylaxis when women lack access to or cannot use oral PrEP.
PrEP -pre-exposure prophylaxis - is medication, usually pills taken daily by HIV-negative individuals to block them from acquiring the virus. Injectible versions are available.
WHO said: "When providing HIV prevention services for women it is important to provide them alongside other services. These include other other HIV prevention choices, STI diagnosis and treatment, HIV tests and links to ART for all women who test positive and a range of contraception methods."
“Research is underway to develop a vaginal ring that includes both contraception and HIV prevention, the WHO added.
Two Phase III studies in Kenya, Malawi, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe found that the ring method reduced the risk of HIV-1 infection in women and was well tolerated with long- term use.
Dapivirine reduces the risk of HIV-1 infection after 24 hours of ring insertion.
International Partnership For Microbicides CEO Dr Zeda Rosenberg said the ring can provide a comprehensive HIV prevention method that could help avert infections not be prevented by another method.
“These findings give hope to many women at high risk who need more and different options to effectively protect themselves from HIV,” Rosenberg said.
“They should replace it with a new one every 28 days as soon as the previous one is removed to maintain its efficacy.”
Women in the study were randomly assigned to two study groups, one used the Dapirivine Ring and the other a placebo ring that contained no drug.
A WHO Guidelines Development Group said that the benefits of the method outweigh disadvantages based scientific evidence.
It said the ring is cost-effective, acceptable, has demonstrated feasibility and has the potential to increase equity as an additional choice.
The research however noted variability in the ring's effectiveness in younger women. Data among pregnant and breastfeeding women was limited.
(Edited by V, Graham)