The purpose of this study is to evaluate the safety of and adherence to a vaginal matrix ring (VR) containing dapivirine and oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in adolescent and young adult females.
This study will evaluate the safety of and adherence to a vaginal matrix ring (VR) containing dapivirine and oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in adolescent and young adult females. The study will enroll healthy, HIV-uninfected adolescent and young adult females between 16 and 21 years of age. Participants will be randomized to one of two sequences of one VR containing 25 mg of dapivirine to be inserted monthly for 24 weeks and one 200 mg FTC/300 mg TDF oral tablet taken daily for 24 weeks. After completing the randomized sequence of two study product use periods, participants will then select between the two study products to use in the final 24 weeks of the trial. Participants will be able to choose either or neither study product during the third product use period. The study includes approximately 76 weeks of follow-up per participant. Participants will attend monthly study visits, which may include behavioral assessments/counseling; physical and pelvic examinations; and blood, urine, and pelvic sample collection.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
247
Vaginal ring containing 25 mg of dapivirine
Tablet containing 200 mg FTC/300 mg TDF
Wits Reproductive Health and HIV Institute CRS (WRHI CRS)
Johannesburg, Gauteng, South Africa
Emavundleni CRS
Cape Town, Western Cape, South Africa
MU-JHU Research Collaboration (MUJHU CARE LTD) CRS
Kampala, Uganda
Spilhaus CRS
Southerton, Harare, Zimbabwe
Number of Participants With Grade 2 or Higher Adverse Events (AEs)
During participants' first year on study (i.e., during first and second product use periods) participants were randomized to use either the dapivirine vaginal ring for 6 months followed by FTC/TDF for 6 months or vice versa. All AEs were reported as per the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events. AEs that were graded as at least Grade 2 (i.e., "moderate" or higher) were classified into the two periods based on reported date of AE onset, with AEs occurring between the participant's randomization date and the date 30 days after their Week 24 visit classified into Period 1, and AEs occurring between their Week 24 visit and the date 30 days after their Week 48 visit classified into Period 2. AEs occurring within 30 days of the Week 24 visit were counted in both periods. This is the number of participant-periods with at least one grade 2 or higher AE by product (combining the two product use periods).
Time frame: Study periods 1 and 2
Number of Participant-Visits With No Product Use
During the study period where participants were randomized to use FTC/TDF they were assessed for FTC/TDF adherence by dried blood spot (DBS) at monthly visits. Results that were below the lower limit of detection (\< 16.6 fmol/punch) were classified as no use of FTC/TDF during the preceding month, and detectable results (\>= 16.6 fmol/punch) classified as at least some FTC/TDF use. During the study period where participants were randomized to use the dapivirine vaginal ring (VR) they were assessed for ring adherence by residual drug levels in returned VRs. Results that were less than or equal to a rate of 0.9mg dapivirine released per month were classified as no use of the VR during that month, and results greater than 0.9mg dapivirine release per month classified as at least some VR use.
Time frame: Study periods 1 and 2
Number of Participant-Visits Reporting Acceptability of Study Product
During the study period where participants were randomized to use FTC/TDF they were asked to rate how much they liked using the tablets for HIV prevention (3 and 6 months after initiating the product). During the study period where participants were randomized to use the dapivirine vaginal ring they were asked to rate how much they liked using the ring for HIV prevention (3 and 6 months after initiating the product).
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Time frame: Study periods 1 and 2
Number of Participant-Visits With No Product Use
During the study period where participants chose which product they used (i.e., Weeks 49-72) they were assessed for FTC/TDF adherence by dried blood spot (DBS) and/or dapivirine vaginal ring adherence by residual drug levels in returned VRs at monthly visits, depending on which product they chose. Results that were below the lower limit of detection (\< 16.6 fmol/punch) were classified as no use of FTC/TDF during the preceding month, and detectable results (\>= 16.6 fmol/punch) classified as at least some FTC/TDF use. Results that were less than or equal to a rate of 0.9mg dapivirine released per month were classified as no use of the VR during that month, and results greater than 0.9mg dapivirine release per month classified as at least some VR use.
Time frame: Study period 3 (Weeks 49-72)
Number of Participants Selecting Each Study Product
During the third study product use period (i.e., Weeks 49-72) participants chose whether to use the dapivirine VR, FTC/TDF oral tablets, or neither product, and could change their decision throughout the 6 month period. Participants were categorized into one of four categories based on their selection pattern: always chose dapivirine VR, always chose FTC/TDF oral tablets, switched at least once (including switching to or from no product), and never chose either product.
Time frame: Study period 3 (Weeks 49-72)
Percentage of Participants Reporting Preference for Dapivirine VR as Compared to FTC/TDF Oral Tablets
Participants were asked "would you prefer to use the ring or the tablets for HIV prevention?" at their enrollment, Month 12, and product use end visit (Month 18) visits.
Time frame: All three study periods (enrollment, month 12, and month 18 study visits)