The PrEP vaginal ring: New deal boosts access for women in Africa

A new partnership between the Population Council and a Johannesburg-based drugs manufacturer is set to make PrEP vaginal rings more widely available and affordable in Africa.

What is the story about?

The PrEP vaginal ring, which reduces the risk of HIV infection by around 30-50%. The ring works by slowly releasing the antiretroviral drug dapivirine and needs to be replaced every month.

Why is it important?

In sub-Saharan Africa, women are disproportionately affected by HIV, with young women most at risk. Women need more HIV prevention methods beyond condoms, which both partners have to agree to use. PrEP is one such alternative, as it puts the person taking it in control. It normally comes as a daily pill. But there are more PrEP options than ever before, including PrEP injections and the PrEP ring.

Following World Health Organization endorsement, Botswana, Kenya, Malawi, Namibia, Rwanda, South Africa, Uganda, Zambia and Zimbabwe have approved the PrEP ring for women at high risk of HIV, while Eswatini and Lesotho have approved PrEP imports. But only a limited number of women in Eswatini, Kenya, Lesotho, South Africa, Uganda and Zimbabwe have access to the ring through implementation studies and pilots.

What is happening?

Currently, a Swedish company makes the PrEP ring. But the Population Council, which owns the rights to the ring, has now signed an agreement with Kiara Health in Johannesburg to make the PrEP ring. Production is expected to start in a few years.

The company will make around 1 million PrEP rings each year, which means more women in Africa will be able to access them. One ring currently costs between US$12 and US$16. This cost is likely to fall once the ring becomes more widely available.

The Population Council is also developing a PrEP ring that works for three months. This would also lower costs as people would not have to buy as many rings. The three-month PrEP ring is likely to be submitted for regulatory approval in the next 12 to 18 months. Kiara Health will also manufacturer this product.

What does this mean for HIV services?

If you work on HIV prevention it is important to know the regulatory status of the PrEP ring in your country. If the dapivirine ring has been approved, there may be a need to convince policymakers to include it as part of the standard HIV prevention package offered to women at high risk of HIV. For further information and inspiration on this, check out the HIV Prevention Manifesto, a campaign run by a coalition of women-led groups in East and Southern Africa.

There is also a need to raise awareness about the PrEP ring among women who would most benefit from it. These communication campaigns should be led and designed by women from different at-risk groups. They should include information about the PrEP ring’s benefits and its potential drawbacks.