Assessing per-sex-act HIV-1 risk reduction among women using the Dapivirine Vaginal Ring
Document Type
Article (peer-reviewed)
Publication Date
4-15-2024
Abstract
Background: Confounding introduced by individuals’ sexual risk behavior is potentially a significant source of bias in HIV-1 prevention intervention studies. To more completely account for sexual behaviors when assessing the efficacy of the monthly dapivirine ring, a new longer-acting HIV-1 prevention option for women, we estimated per-sex-act risk reduction associated with product use. Methods: We conducted a secondary analysis of data from MTN-020/ASPIRE, a phase 3, randomized, placebo-controlled efficacy trial of the dapivirine ring that recruited HIV-uninfected, African women aged 18–45 years. With cumulative sex acts as the time scale, we used multivariable Cox regression with inverse probability of censoring weights to estimate HIV-1 risk reduction associated with a rate of dapivirine release indicative of consistent product use. Results: Women in the dapivirine ring group (n = 1187) had an estimated incidence rate of 2.3 (95% confidence interval [CI], 1.8–3.1) HIV-1 acquisition events per 10 000 sex acts versus 3.6 (95% CI, 2.9–4.4) per 10 000 acts in the placebo group (n = 1187). Dapivirine release indicative of consistent ring use was associated with a 63% (95% CI, 33%–80%) per-sex-act HIV-1 risk reduction. Conclusions: These results support the efficacy of the dapivirine vaginal ring for HIV-1 prevention and help to inform decision-making for women, providers, and policymakers regarding product use.
The dapivirine vaginal rings used in this study were developed and supplied by the International Partnership for Microbicides (IPM).
Recommended Citation
Stalter, Randy M., Tracy Q. Dong, Craig W. Hendrix, Thesla Palanee-Phillips, Ariane van der Straten, Sharon L. Hillier, Flavia M. Kiweewa, Nyaradzo M. Mgodi, Mark A. Marzinke, Linda-Gail Bekker, Lydia Soto-Torres, Jared M. Baeten, and Elizabeth R. Brown, for the MTN-020/ASPIRE Study Team. 2024. "Assessing per-sex-act HIV-1 risk reduction among women using the Dapivirine Vaginal Ring," Journal of Infectious Diseases 229(4): 1158–1165.
DOI
10.1093/infdis/jiad550
Language
English
Project
The Dapivirine Vaginal Ring for HIV Prevention; International Partnership for Microbicides (IPM)