Do microbicides offer new hope in Rwanda’s war on HIV/AIDS?

The following article was suggested by one of our readers—if theres an idea you would like us to cover, please submit it here. A decade ago, The New Times reported how novel HIV/AIDS prevention measures known as microbicides were set to be introduced for women, should they prove to be effective after trials. At the time, Evelyne Kestelyn, the Scientific Manager of Project Ubuzima, an international non-governmental organisation that promoted reproductive health and HIV prevention, said the International Partnership for Microbicides (IPM) was considering two forms of microbicides, a gel and a ring. Project Ubuzima turned into a local NGO called Rinda Ubuzima in 2014. It is a research centre based in Kigali where it operates in partnership with different actors in the health sector. Marie Michele Umulisa, the Executive Director of Rinda Ubuzima. Photo: File. Research for new prevention measures for women came up due to the fact that women may fail to negotiate safer sex with men. The new methods would enable women to, more than ever before, take charge of their lives. Once microbicides are used by a woman during intercourse, her partner cannot know. The new methods were not supposed to replace existing preventive measures, but to compliment behaviour change, abstinence, male and female condoms, male circumcision and others like HIV vaccines. Marie Michele Umulisa, the Executive Director of Rinda Ubuzima, told The New Times that regarding how far research and use of microbicides has gone in Rwanda, “we have been partnering with IPM since 2004 and we have conducted its phase 1 and 2 trials.” In July, she said, IPM received positive feedback from the European Medicines Agency (EMA) and they have also “received WHO prequalification for the Dapivirine Ring.” Umulisa explained: “This (Dapivirine Ring) is a vaginal ring that, after being approved by regulatory bodies, will significantly reduce new HIV infections amongst the women population. The Dapivirine Ring is a woman-centred tool that will be used as an HIV prevention tool.” The ring is one of the HIV prevention options specifically designed for women, confirmed Eric Remera, the Acting Division Manager for HIV/STIs and Viral Hepatitis at the Rwanda Bio-Medical Centre (RBC). “It may be one of the prevention options; because it is not yet fully approved,” he said. HIV prevalence in Rwanda stands at 3% with 2.5% in rural areas, and 4.8% in urban areas, according to latest figures from the Ministry of Health. Available data also shows that more women (3.7%) are infected compared to men (2.2%). In sub- Saharan Africa, women and girls are said to account for 60 percent of the people living with HIV. If the ring is proven effective, Remera observed, it will be useful in some populations like the female sex workers who have a high prevalence of 35.5%. Remera also noted that 3% of couples in Rwanda are discordant “and this may reduce seroconversion – which implies eventually turning positive, or getting infected.” Seroconversion is the medical term used for the transition from infection with HIV to the detectable presence of HIV antibodies in the blood. When seroconversion occurs (usually within a few weeks of infection), the result of an HIV antibody test changes from HIV negative to HIV positive. Umulisa said statistics have been showing that young girls and women especially in Sub-Saharan Africa are at some point vulnerable when it comes to decision-making regarding STIs, HIV/AIDS prevention. She said: “Women have been left out whenever it was about their choice regarding HIV prevention. We are glad that IPM has taken into consideration the abyssal need that women had and developed this Dapivirine Ring. I am confident this new tool is a way to protect women from new HIV infections.” ‘Excellent news’ Now, Umulisa explained, the next steps are the adoption of the Dapivirine Ring by regulatory bodies as an added tool in the fight against HIV. “We are conducting informative sessions with different key actors,” she said, noting that if everything goes well more media engagement will be done before the end of this year. “For a new tool or medicine to be registered and approved for use it has to go through different procedures. As of now, we are receiving excellent news regarding its adoption,” Umulisa said. Another great news to share, Umulisa noted, is that since women in Rwanda participated in the development of the Dapivirine Ring in its early stages, Rwanda is among the first countries that will receive it. “Therefore, Rinda Ubuzima, as the organisation that was conducting the clinical trials in Rwanda, we are grateful that the Ministry of Health and the Rwanda Biomedical Centre have been of great support throughout this journey,” she said. The study ended in 2016, with participants, ages 18 to 45, across six sites in South Africa and one in Uganda. Rwanda did phase I and II, assessing safety and acceptability. Phase III looked at the efficacy of the dapivirine ring. Generally, more than 800 Rwandans participated in the study.

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Do microbicides offer new hope in Rwanda’s war on HIV/AIDS?