Uptake of dapivirine vaginal ring and oral pre-exposure prophylaxis among women accessing HIV prevention services in South Africa: a cohort study
Summary
Background
Introduction of the dapivirine vaginal ring has paved the way for multimethod HIV pre-exposure prophylaxis (PrEP). We aimed to investigate PrEP method preference when offered within integrated, primary care HIV prevention.
Methods
Data are derived from an implementation science project assessing integration of PrEP as part of combination HIV prevention and sexual and reproductive health services. Eligible participants were women aged 18 years or older who were HIV-negative, and neither pregnant nor breastfeeding. Women were enrolled in a cohort offering ring and oral PrEP in six facilities and three mobile clinics in South Africa between August 2023 and April 2024. We describe PrEP method uptake and self-reported reasons for method choice at enrolment. We used log-binomial regression to estimate unadjusted risk ratios (RRs) and modified Poisson regression with robust variance to identify factors associated with ring uptake. On-time 1-month return among those initiating PrEP was described. Probabilities of PrEP interruption were estimated and the survival distribution explored using a Cox proportional hazards regression model.
Findings
Among 2325 women, 76·0% chose oral PrEP, 14·9% ring PrEP, and 9·0% no PrEP. Compared with women aged 18–24 years, those aged 25–34 years (adjusted RR [aRR]=3·01, 95% CI 2·36–3·84) and aged 35 years or older (3·49, 2·41–5·45) were more likely to select ring PrEP, as were those who had used oral PrEP previously (1·43, 1·11–1·85). Those with symptoms or signs of sexually transmitted infection (0·37, 0·19–0·72) or currently using oral PrEP (0·63, 0·49–0·82) were less likely to select rings. Women selected the method that felt safest, was easiest to use, and aligned to their individual lifestyles. On-time 1-month return among new PrEP initiations was higher in those initiating ring PrEP (46·5%, 95% CI 38·5–51·7) than in those starting oral PrEP (26·1%, 23·0–29·8), and PrEP interruptions were higher among those using oral PrEP than in those using ring PrEP (hazard ratio=2·2, 95% CI 1·60–3·00, p<0·0001).
Interpretation
Choice-based PrEP delivery allows women to select a formulation that aligns with their individual preferences and may improve PrEP use. Although there was a preference for oral PrEP compared with ring PrEP, on-time 1-month return was higher and PrEP interruptions lower among women choosing the ring.
January 2026
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Resource Type:
Citation:
Authors: Martin, C.E., Ramatsoma, H., Chidumwa, G., Nongena, P., Letsielo, M.J., Kutywayo, A., Koloane, N., Ncube, S., Mdluli, N., Nattey, C., Mullick, S.
Health Risks(s):
- HIV
Product type(s):
- ARVs
- MPTs
Topic(s):
- MPTs
Region(s)
- Africa
Additional Keywords:
PrEP; sexual and reproductive health; unintended pregnancy; multipurpose prevention technologies; MPTs; HIV; dapivirine vaginal ring