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Vaginal ring for HIV prevention: a few details would have elevated good coverage to great

A Vaginal Ring Could Prevent HIV, Two Huge Studies Just Found

Our Review Summary

Vaginal ring. Credit: International Partnership for Microbicides

Vaginal ring. Credit: International Partnership for Microbicides

This article discusses two studies surrounding a new device for preventing HIV infection. The device is a vaginal ring that dispenses an antiviral compound called dapivirine which can prevent the spread of HIV in women, according to scientists presenting their research at a medical conference. The device must be worn daily and replaced monthly in order to be effective. One of the studies described was published in the New England Journal of Medicine (NEJM) and the other was an unpublished abstract. The ring contains an antiviral agent that works against the virus, but experts caution this method only seems to curb about 27 percent of transmissions from one sexual partner to the other. This story does a good job of providing context, although we would have liked a more cautious headline (and less use of the word “huge,” in general, in the text) and a better definition of pre-exposure prophylaxis since previous efforts have mainly focused on treating those who already contracted the virus. We applaud the careful way the story gave details of the two research studies, including their size and length and where they were conducted. Because sub-Saharan Africa is hardest hit by HIV, and has few health resources, we wish the story had included discussion of how much the ring will cost.

 

Why This Matters

Women and men worldwide are at risk of catching the HIV virus from sexual partners. While there are precautions that might limit the spread, they are often not under the control of women. This vaginal ring, with a compound that interferes with the virus, could be worn discreetly by women to protect themselves. While the 27 percent effectiveness may seem modest, these two studies being reported raise a new hope for putting control of limiting the spread of the virus into more women’s hands.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story would have benefited by spending even one sentence on cost, since HIV is especially prevalent in countries with few resources. Will the ring be cheaper or more expensive than the pill? If the ring must be replaced monthly, what does that mean for the cost, and will people be more likely to fail to buy the replacements because of cost?

There was a lost opportunity here to compare the cost of the vaginal ring versus Truvada, the currently available option for pre-exposure prophylaxis.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story gives numbers supporting the benefits claim in both of the studies mentioned, but they’re relative, presented in terms of a percentage, not absolute which relates to the actual numbers of patients, which are more definitive and useful for readers. The study published in the NEJM showed that the ring, used by volunteers, cut infections by 27 percent over a control group. The absolute numbers were included right in the studyabstract (but not the story) and were reported this way:

Among the 2629 women who were enrolled, 168 HIV-1 infections occurred: 71 in the dapivirine group and 97 in the placebo group (incidence, 3.3 and 4.5 per 100 person-years, respectively).

For another — unpublished study — the story reported a difference in effectiveness by age. The ring showed no impact on those age 21 and younger, but reduced new HIV cases by 37 percent in women over 21. We were glad to see the quote from a scientist explaining that how carefully the device is used may explain the difference in outcomes by age and warrants more study.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

We would have liked to see some mention of whether there might be any harms associated with this. It is possible that long-term use might pose risks that don’t show up in shorter studies. The story does not even say, “We don’t know of any harms.”

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story explains the size of the studies — each including at least 2,000 women. One study was already published in the NEJM and the other is not yet published. Some of the details given help establish the credibility of the results, although we are not given much detail about study protocols. It would have been helpful to link to the conference abstract, similar in the way it linked to the NEJM study, for readers that wanted a bit more detail.

Does the story commit disease-mongering?

Satisfactory

There was no disease mongering.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story doesn’t mention the makers of the device or any potential conflicts of interest. However, one of the authors of the study presented in abstract form (the “SPIRE” study) is affiliated with the International Partnership for Microbicides, Silver Spring, MD, which is involved with product development, partnerships with pharmaceutical companies, and marketing of this and related devices. The device is licensed from Janssen Sciences, a large pharmaceutical company. The International Partnership for Microbes describes itself this way: “As a nonprofit product developer, IPM partners with a variety of organizations to facilitate strategic planning from the earliest stages of product design to ensure future access to products.”

There are two people quoted in the story, the lead author of the study and the head of AVAC, a global HIV-prevention advocacy group. (AVAC issued a news release on the two studies.) While the story includes insightful comments from these two sources, both have some investment (even if only on an intellectual level) in the project. The story would have been been stronger if it had included an expert with no relationship at all to the device studies, ideally someone active in providing health care in sub-Saharan Africa, who might have provided insights into adherence, product acceptance or any practical obstacles (such as costs) in the way.

Does the story compare the new approach with existing alternatives?

Satisfactory

A discussion of the alternatives is a real strength in the article. It mentions other rings in development as well as the Truvada pill which offers some protection against HIV, and examines some pros and cons of the different methods.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story says that the dapivirine ring “has been in development for more than a decade,” suggesting that it is not yet available. Some comment on when the device might become available would have been useful.

Does the story establish the true novelty of the approach?

Satisfactory

The story tells us that vaginal rings already exist and are in widespread use but that the addition of the dapivirine antiviral agent makes this device novel. It also states that the well-known Nuvaring used to prevent pregnancy uses the same delivery method.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Since the article uses quotes not found in a news release on the studies, we are confident the story does not rely solely on a PR release.

Total Score: 6 of 10 Satisfactory

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