Research Highlights

MTN-020/ASPIRE - SAFETY AND EFFICACY OF THE DAPIVIRINE VAGINAL RING

HPRU participated in one of the first women-initiated methods for HIV prevention.

The MTN-020/ASPIRE study evaluated the safety and efficacy of the dapivirine vaginal ring (VR) (25 mg) for the prevention of HIV-1 infection in healthy, sexually active, HIV-negative women. MTN 020/ASPIRE demonstrated that the monthly dapivirine vaginal ring is safe for long term use and can reduce the risk of HIV-1 infection in women when used. Protection was greater in subgroups with evidence of better adherence to ring use. In MTN 020/ASPIRE, the dapivirine ring reduced the risk of HIV infection by 27% overall, and showed a greater level of protection for women over 21 (56%).  IPM 027/The Ring Study showed similar results.

This led to the product to be tested in an “open label” trial (MTN 025), which will assess its use by previous participants in more “real life” situations. We hope that the additional data obtained by the open label HOPE study will lead to licensure of the first women- initiated HIV prevention technology. We anticipate the results in the latter part of 2018. Should we be successful, the study will have implications on policy as well as public health

J.M. Baeten et al. Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women. NEJM DOI: 10.1056/NEJMoa1506110

CONTRIBUTION TO NUMEROUS VACCINE CONCEPTS FOR HIV PREVENTION

HPRU is contributing to the HVTN’s (HIV Vaccine Trials Network) mission “to fully characterize the safety, immunogenicity, and efficacy of HIV vaccine candidates with the goal of developing a safe, effective vaccine as rapidly as possible for prevention of HIV infections globally”; as well as HPTN’s (HIV Prevention Trials Network) mission “dedicated to the discovery and development of new and innovative research strategies to reduce the acquisition and transmission of HIV”. In this regard, the following studies have been undertaken: HVTN 100; HVTN 111; HVTN 702; HVTN 703/HPTN 081; HVTN 705.

INNOVATIVE LONG-ACTING INJECTABLE FOR HIV PREVENTION (HVTN 084)

A Phase 3 Double Blind Safety and Efficacy Study of Long-Acting Injectable Cabotegravir Compared to Daily Oral TDF/FTC for Pre-Exposure Prophylaxis in HIV-Uninfected Women

BEHAVIOURAL RESEARCH

Translating PrEP uptake by adolescents. Developing a Gender-Enhanced PrEP Information-Motivation Workshop for Young South African Women

COMBINATION PREPVACC

Innovative trial with combined prevention interventions. To start 2019.

HORMONAL CONTRACEPTION (HC) AND RISK OF HIV ACQUISITION
Observational data suggested that hormonal contraception and in particular Depo-Provera increases the risk of HIV acquisition. We investigated the association between hormonal contraception and risk of HIV seroconversion and prevalence of other STIs. Data from 2236 participants recruited from microbicide trials were analysed to assess the association between HC and HIV. We show that in our setting HC was the most common contraception (46.47%). Use of HC was significantly associated with increased risk for HIV acquisition (HR 1.72: 95% CI 1.19-2.49, P<0.005). HC was also significantly associated with a higher prevalence of C. trachomatis (adjusted OR 2.46, 95%CI 1.52-3.97, P<0.001). HC are highly effective and well tolerated family planning methods. However, evidence suggests it may increase risk of HIV acquisition and it is recommended that women are counselled on importance of dual protection such as with male condoms in high HIV prevalence settings. This study was used as evidence for the WHO guiding document on HC and HIV prevention. Women should be encouraged to use other long acting contraception such as IUCD and contraceptive transdermal patches (such as Evra®). The NDOH has embarked on a drive to introduce these in Family Planning Clinics in South Africa. I developed the concept and co-wrote the manuscript.

Handan Wand and Gita Ramjee. The effects of injectable hormonal contraceptives on HIV seroconversion and on sexually transmitted infections. AIDS 2012. 26:375-380

 

 

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