Roselyne Sachiti in CHICAGO, US
New findings presented at the HIV Research for Prevention 2016 conference currently underway in Chicago, United States have revealed how social harms such as gender-based violence, especially intimate partner violence have a negative effect on adherence. As a result of intimate partner violence, some women under the ASPIRE study stopped using the ring.

The findings presented by the Microbicides Trials Network (MTN) here said of the 2 629 women enrolled in ASPIRE study, a large HIV prevention trial of a monthly vaginal ring, 5 percent (85 participants) reported that they were subject to and feared intimate partner violence.

Zimbabwe is one of the African countries, including South Africa, Malawi and Uganda that were part of the ASPIRE study. The research findings said those who stopped using the ring were an overall 1,5 times likely to use the ring, and were 2,5 times unlikely to use the ring if they had experienced a form of intimate partner violence.

However, the use of the ring improved after the abused women disclosed the events to study staff, proving how counselling and support could improve adherence in these women. Director of Network Trials at the Witwatersrand Reproductive Health and HIV Institute in Johannesburg, Dr Thesla Palanee Phillips said violence against women remains a significant challenge globally, particularly so in communities where they conducted ASPIRE.

“Disclosing exposure to intimate partner violence was a major step forward for many of these women, who are often too afraid to talk openly, and an acknowledgement to trial sites who created safe environments women felt comfortable to seek help from,” said Dr Palanee Phillips.

Women most likely to report intimate partner violence or related harms during ASPIRE were between the ages of 18 and 21 when they enrolled; had a new primary partner or not disclosed study participation or ring use to their primary partner.

The analysis was based on behavioural and demographic data collected when participants first enrolled into ASPIRE and questions asked of women at different time points during the study, as well as information from participants who came forward on their own.

Researchers also looked at drug levels in blood as a measure of adherence. “Looking ahead, we need to find simple ways to empower women with support to be adherent to HIV prevention strategies in the face of potential exposure to intimate partner violence. We need to ensure that women feel comfortable reporting social harms in studies and in seeking help so that we can better understand how to protect all women against HIV infection,” added Dr Palanee Phillips.

ASPIRE — a study to prevent infection with a ring for Extended Use or MTN-020, was a Phase III trial designed to determine whether a vaginal ring containing an anti-retroviral (ARV) drug, dapivirine is safe and effective in protecting women against HIV when used for a month at a time.

The trial was led by the National Institutes of Health-funded Microbicides Trials Network and enrolled women between 18 and 45 years at 15 trial sites in Malawi, Uganda, South Africa and Zimbabwe.

The dapivirine ring was developed by the International Partnership for Microbicides, which also conducted the Ring Study, a Phase III sister study. ASPIRE’s primary results, which were reported earlier this year found the dapivirine ring both safe and helped protect against HIV with risk being reduced by 27 percent overall.

Additional analyses have since found the level of HIV protection is at least 56 percent and may be as high as 75 percent or more when the ring is used most consistently.

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