TY - JOUR
T1 - Brief Report
T2 - Dapivirine Ring HIV-1 Prevention Effectiveness for Women Engaged in Vaginal and Anal Intercourse: Insights from Mathematical Modeling
AU - Peebles, Kathryn
AU - Brown, Elizabeth R.
AU - Hendrix, Craig W.
AU - Palanee-Phillips, Thesla
AU - Van Der Straten, Ariane
AU - Harkoo, Ishana
AU - Reddy, Krishnaveni
AU - Mirembe, Brenda G.
AU - Jeenarain, Nitesha
AU - Hillier, Sharon L.
AU - Baeten, Jared M.
AU - Barnabas, Ruanne V.
AU - Soto-Torres, Lydia
AU - Schwartz, Katie
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Background:The dapivirine vaginal ring reduces the risk of HIV-1 acquisition in acts of vaginal intercourse (VI), and although it does not offer HIV-1 protection in acts of anal intercourse (AI), it may provide some overall risk reduction for women for whom most sex acts are vaginal. We estimated the protective effect of the ring among women with high ring adherence engaged in both VI and AI.Methods:We developed a microsimulation model using data from the MTN-020/ASPIRE trial. Among women who reported any AI, we estimated the proportion of all sex acts that were AI. Model scenarios varied this proportion among women engaged in both VI and AI from 5% to 30%, including the trial-observed median proportion of 6.3% of all acts being AI. In primary analyses, dapivirine ring efficacy was model-calibrated at 70% for vaginal exposures and assumed to be 0% for anal exposures.Results:Among highly adherent women for whom 6.3% of sex acts were AI, the ring reduced HIV-1 risk by 53% (interquartile range: 44, 60), with a decline to 26% (interquartile range: 16, 36) among women for whom 30% of acts were AI. Ring effectiveness was less than 40% among women for whom AI accounted for greater than 16% of all sex acts, although this represented less than 5% of all women in the ASPIRE trial.Conclusions:For most women, including those who engage in AI, because most HIV-1 risk occurs in acts of vaginal sex, the dapivirine vaginal ring can provide important HIV-1 protection.
AB - Background:The dapivirine vaginal ring reduces the risk of HIV-1 acquisition in acts of vaginal intercourse (VI), and although it does not offer HIV-1 protection in acts of anal intercourse (AI), it may provide some overall risk reduction for women for whom most sex acts are vaginal. We estimated the protective effect of the ring among women with high ring adherence engaged in both VI and AI.Methods:We developed a microsimulation model using data from the MTN-020/ASPIRE trial. Among women who reported any AI, we estimated the proportion of all sex acts that were AI. Model scenarios varied this proportion among women engaged in both VI and AI from 5% to 30%, including the trial-observed median proportion of 6.3% of all acts being AI. In primary analyses, dapivirine ring efficacy was model-calibrated at 70% for vaginal exposures and assumed to be 0% for anal exposures.Results:Among highly adherent women for whom 6.3% of sex acts were AI, the ring reduced HIV-1 risk by 53% (interquartile range: 44, 60), with a decline to 26% (interquartile range: 16, 36) among women for whom 30% of acts were AI. Ring effectiveness was less than 40% among women for whom AI accounted for greater than 16% of all sex acts, although this represented less than 5% of all women in the ASPIRE trial.Conclusions:For most women, including those who engage in AI, because most HIV-1 risk occurs in acts of vaginal sex, the dapivirine vaginal ring can provide important HIV-1 protection.
KW - HIV-1 prevention
KW - HIV-1 risk
KW - dapivirine vaginal ring
KW - receptive anal intercourse
KW - sub-Saharan Africa
KW - women
UR - http://www.scopus.com/inward/record.url?scp=85146139671&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85146139671&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000003110
DO - 10.1097/QAI.0000000000003110
M3 - Article
C2 - 36184755
AN - SCOPUS:85146139671
SN - 1525-4135
VL - 92
SP - 122
EP - 126
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 2
ER -