© Marc Bruxelle
The REACH study found that 97% of women and girls in Uganda, South Africa and Zimbabwe are happy to work with HIV prevention methods – globally, half of all people living with HIV are women
Globally, more than half of all people living with HIV are women, and in sub-Saharan Africa, women account for more than 60% of adults with HIV.
Rates of infection are especially high among adolescent girls and young women. In 2020, one in four new infections in sub-Saharan Africa were in young women ages 15-24 – despite making up 10% of the population.
Why are women and young girls at risk of HIV?
Kelly Austin, associate professor of sociology at Lehigh University and not involved in this study, said: “Women in less-developed countries disproportionately bear the burden in terms of ill health when facing food insecurity or a shock or disaster like drought that impacts the ability to get food or harvest food.”
Essentially, lack of resources can lead to sexual assault, marriages of economic necessity and the resultant transmission of HIV.
What is the REACH study?
The REACH study, Reversing the Epidemic in Africa with Choices in HIV prevention, is ongoing at four clinical research sites in Uganda, South Africa and Zimbabwe by the National Institutes of Health-funded Microbicide Trials Network (MTN). Essentially, it is working to stop the HIV epidemic – by protecting women and girls.
In this trial, they asked young girls and women to use a vaginal ring and daily oral PrEP as HIV prevention methods. The ring works by releasing the antiretroviral drug dapivirine from the ring into the vagina slowly over 28 days.
The participants are given extensive support and counselling focused on helping them to use their product as best they can. Every monthly visit includes a meeting with a counsellor, and participants can also choose from a menu of additional forms of support, including daily text messages or weekly check-ins by phone, having a “Peer Buddy”, and adherence support groups.
Out of 247 participants, 97% used both the vaginal ring and daily PrEP pill “some or all of the time.”
Only less than three percent of trial participants used neither.
‘Remarkable during time of COVID’
“What strikes me most about REACH is that not only are we seeing high adherence, but persistence appears to be high as well. Clearly, the ongoing support and individual attention paid to participants seems to make a difference,” said Connie Celum, M.D., M.P.H., professor of global health and medicine and director of the International Clinical Research Center at the University of Washington in Seattle.
“To see this kind of high adherence – it’s pretty remarkable, especially during this time of COVID-19.”
‘Results exceeded even our own expectations’
Gonasagrie (Lulu) Nair, MBChB, MPH, REACH protocol chair and senior lecturer, Centre for Medical Ethics and Law, Faculty of Medicine, at Stellenbosch University in South Africa, said: “In many ways, these results exceeded even our own expectations, yet at the same time, it’s not surprising to find that these young women have the capacity and desire to protect themselves against HIV.
“They simply need to feel empowered and have the agency to make choices based on what they feel is right for them.”
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