Tag Archives: HIV

Dapivirine vaginal ring should be rolled out to the public

…as South Africa orders 16 000

Dr Were

Dapivirine vaginal ring should be rolled out to the general public

 

BY MUNYARADZI BLESSING DOMA

 

The dapivirine vaginal ring which has proved to be an effective HIV prevention tool should be rolled out to the general public so as to give people more options in the fight against the epidemic, a Kenyan Behavioural Scientist and Public Health Expert has revealed.

Doctor Daniel Were revealed this in Nairobi during a recent media symposium with senior health journalists from Kenya, Tanzania, Uganda, Zambia, Malawi and Zimbabwe.

The symposium was hosted by AVAC and MESHA.

Doctor Were said that while countries acted differently when it comes to HIV prevention, it was vital that others learn from those who would have led on such initiatives.

“What we have seen overtime is that there are countries where the governments move very fast, and there are countries where the governments move much slower as far as prevention is concerned.

“The important thing here is how do we use those countries that are on the forefront to try and encourage the others to also go faster,” said Dr Were.

He added, “this is a call to the government but also other donor agencies that work closely with the Kenyan government that how do we fast track the availability of these products to be available to the public.

“When I talk about fast tracking, there are issues around procurement to make sure that the product such as the dapivirine ring are available,” said Dr Were.

He said the dapivirine vaginal ring whose studies had proved 35 percent efficacy, was not yet available to the general public in Kenya but only for trials.

Dr Were also revealed that the dapivirine vaginal ring which is inserted every 28 days, costs US$7 to produce and US$12-US$13 to procure.

Bridget Jjuuko from AVAC, said failure to implement the roll out of the ring could be linked to funding, hence governments had to find other sources of funding.

“We have seen that the ring is not going to be funded by PEPFAR, so if PEPFAR is not going to be funding the ring, who else is going to fund the ring,” quizzed Jjuuko.

Jjuuko also revealed that allocation of resources towards HIV prevention for women and girls was what the Choice Manifesto was all about, which is an initiative on women led HIV prevention interventions which was launched in Uganda in September.

And true to Dr Were’s assertion on how governments respond differently, Zimbabwe, Kenya, Uganda and South Africa who had all given the nod to the dapivirine vaginal ring, were beaten to it by the latter which recently revealed that it was set to start a roll out for use by the general public.

AVAC in its Weekly News Digest of September 29 reported that South Africa, which has the largest epidemic of the virus in the world, was soon going to roll out the vaginal ring.

“The Global Fund to Fight AIDS, Tuberculosis and Malaria said three groups involved in the fight against AIDS in the country have with its support, placed an initial order of 16 000 rings-that are expected to become available in the coming months,” read the report.

While Zimbabwe was one of the countries to have approved the ring, unlike its neighbour South Africa, the HIV prevention option is not yet available to the general public.

Pangea Zimbabwe AIDS Trust (PZAT) Senior Programs Manager, Definate Nhamo told this reporter that in Zimbabwe “the ring is currently not available to the general public.

“It is only available through implementation science studies.”

According to the International Association of Providers of Aids Care, the dapivirine vaginal ring is a flexible vaginal ring made of silicone and slowly releases an antiretroviral (ARV) medication called dapivirine over the course of one month to reduce the risk of HIV infection.

The dapivirine vaginal ring which is a form of Pre-Exposure Prophylaxis (PrEP), is termed a female initiated option to reduce HIV infection.

According to the NHS Inform, pre-exposure means it’s taken before sex and prophylaxis means to prevent disease-in this case, by stopping one from getting HIV if taken correctly.

Speaking further on the dapivirine vaginal ring, Dr Were revealed that it was one of the options for HIV prevention because “available methods have not done enough to slow the epidemic among women and there was need for discreet products that women can use on their own terms.

“No one product will solve the HIV epidemic hence women need multiple prevention options that make sense for their lives.”

He added that from the researches that were done among women on the dapivirine vaginal ring, it was shown that they (women) were comfortable with it, as they did not feel it during any of their daily activities.

Dr Were also revealed that the women said they were willing to use it if effective and it has little or no impact on sexual experience and while on their period.

He also revealed that for men who were with someone putting on the dapivirine vaginal ring; most did not feel it during sex, no impact on sexual pleasure.

Dr Were also revealed that that in preparing for the dapivirine ring introduction, there was a pathway to achieve scale up.

“Regulatory approval; submission of regulatory dossiers for product approval from local national health product bodies.

“Government buy in; in order for a health product to be adopted into government policy, plans for introduction are developed through national technical working group structures and national level committees.

“Prior project projects donor funded sites; prior to large-scale up roll out pilot studies which are often donor funded are conducted across sites and populations to determine feasibility and the most effective implementation strategies.

“Broader scale roll out (government clinics) once pilot studies have demonstrated feasibility and the most effective implementation strategies, these strategies are applied to a broad scale public health roll out,” said Dr Were.

Following South Africa’s giant leap, it now remains to be seen whether other African countries where the ring has been approved, will also make orders for the use by the general public.

 

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Collaborations needed in circumcision drive

PSH Operations Research Specialist Handrick Chigiji-pic by Daphne Machiri

BY MUNYARADZI BLESSING DOMA

Health authorities are collaborating with traditionally  circumcising communities so that they can find common ground on how best they can work together in promoting one of HIV’s prevention methods.

And the results have been good as some of the communities like the VaRemba, have warmed up to the idea of working with the Ministry of Health and Child Care and its supporting partners.

This was revealed by Handrick Chigiji, Operations Research Specialist at Population Solutions for Health, on the sidelines of the recently held National AIDS Council HIV Research Symposium.

Chigiji’s sentiments follow revelations by some members of the traditionally circumcising communities emphasizing on proper collaborations so that they can work with health authorities in their circumcision drive. 

National AIDS Council defines male circumcision as the surgical removal of the fold of the skin that covers the head of the penis (foreskin or prepuce).

“There have been efforts to work together with these groups and one of them is the VaRemba Traditional Ceremonies that we are also trying to come in and provide support in terms of ensuring that they can continue with their ceremonies, the male circumcision; where the procedures are being done medically so there are engagements already.

“Last year we provided that support through the Ministry of Health and other partners to ensure that is done.

“And this year again, the ceremony was done in Buhera, the team from Ministry of Health got support from other partners to ensure that service in a safer way.

“And also for them to get all the support they require and that team was ensuring that the service is done in a medical way,” said Chigiji.

Chigiji further revealed that the visit to the VaRemba community had also given them the opportunity to collect necessary data on the Shang ring, which is another male circumcision option.

“Basically we also took that opportunity to capture the data on the Shang ring and we captured their experiences as well, in terms of their acceptability so we are getting the request to support their ceremonies.

“It also shows that the ring has been accepted because it’s now being utilised, so we got a number of clients who were circumcised with the ring but also there are some who also prefer the surgical so it gives them a wider choice because we have these methods being offered.

“So it gives the clients, the option to choose when they have more than one option,” added Chigiji.

A member of the VaRemba community who attended the symposium said health authorities should find ways of collaborating with their communities so as to co-exist in the circumcision drive.

He added that it were better if health authorities train some of their members so that they can in turn pass on the knowledge to their peers.

“It would be better if health authorities train one of us than for them to think we can allow them to come and circumcise our members during our ceremonies.

“Circumcision is something we have been practicing before all these efforts, so there is need for some serious collaborations if we are to work together,” he said.

Fair Planet reports that as part of the VaRemba male rites of passage, boy and men from the age of 12 are taken for initiation rituals during winter. It is during these initiation ceremonies that the boys get to be circumcised.

It is reported that in 2007, the joint United Nations Programme on HIV/AIDS and WHO recommended voluntary medical male circumcision (VMMC) to reduce the risk of men acquiring HIV infection during heterosexual exposure.

The World Health Organisation further revealed that the recommendation was based on strong evidence from randomized controlled trials showing an approximately 60 percent lower risk. 

It is also added since 2007, more than 27 million VMMC procedures have been performed in the 15 priority countries in Eastern and Southern Africa.