Cross-country Learning Builds Momentum for a New HIV Prevention Product

Speeches Shim

Dapivirine vaginal ring (“PrEP ring”) advocates, Microbicide Trials Network (MTN) ring researchers, and a PrEP ring user convened at a May 2021 advocacy event in Lusaka, Zambia to share cross-country learnings and insights for introducing the PrEP ring as part of HIV prevention programming. Ruth Nahurira, an experienced PrEP ring user and former ASPIRE and HOPE study participant shared her experiences with the group.

“For the first time in my life, I would see someone who was in the study talking confidently about the product: how it has worked for them and why they value the product,” said Chilufya Hampongo of the Treatment Advocacy and Literacy Campaign. “That gave me as an advocate ground to speak with confidence, knowing that there is someone out there who sees the value of the ring as a participant and is still confident about using it in the real world.”

Advocacy groups and supporters of the PrEP ring in eastern and southern Africa have been strategizing and planning for ring introduction in advance of The World Health Organization’s updated guidelines on HIV prevention, testing, treatment, service delivery, and monitoring. For the first time, the updated guidelines now include the PrEP ring and workshops with PrEP ring users and researchers provide valuable insights for countries to consider when implementing the ring as part of HIV prevention programming.

Mumba Ngoma, who works with Zambia’s Community-Based TB/HIV/AIDS Organization, said that hearing from the PrEP ring user and researchers from Uganda helped make the work feel more practical. “We were getting testimony from users in Uganda, and this moved us away from theory,” he said. “It was now coming out in a very practical sense, so for me that was very important. In terms of advocacy, this testimony is a good tool. We learned a lot from the user and provider perspectives.”

Ms. Hampongo felt the workshop, which was convened by the PROMISE collaboration [PDF, 111K], provided an exceptional opportunity to think about messaging – both the language and the audience. “From experience in advocacy, you come up with so many nice strategies but the people you are targeting might not be the right ones,” she noted. “But this workshop gave us time to think through who we really need to reach out to.”

Dr. Carolyne Akello, lead investigator with The Makerere University - Johns Hopkins University (MU-JHU) Research Collaboration in Uganda was impressed by Zambia’s interest in learning more about ring introduction. “Our experience with the ring studies has given us a wealth of practical information that we can share with others,” she said. “It was great to see a country so interested in the ring with many stakeholders gathered together to discuss roll-out in their country.” According to Dr. Tendai Munthali of the Zambian Ministry of Health HIV Prevention Program, hearing the Ugandan experience “helped put a human face to the study. It also made me see that implementing the [PrEP] ring is possible,” she said. “Reading and hearing about a study is one thing but hearing from people who have implemented is something else. It brings everything to life!”

Ugandan healthcare providers virtually attended and brought with them a placebo ring and pelvic model to give participants an idea of the shape and feel of the product. “When [women] have something to look at and be shown where the PrEP ring sits when it is fitted, I’m sure it will give them more confidence to use the ring,” Ms. Hampongo noted. “I believe not so many women know their anatomy fully well and as such there is some skepticism when it comes to using options that need to be inserted. Their experience gave me so much zeal to advocate for this product and engage with healthcare providers to get their feedback on whether we can do the same in Zambia during counseling,” she said.

The exchange helped build knowledge while also strengthening the ties between the two countries’ HIV prevention work. “Zambians are open to learning and seeing how best to improve the health of their citizens,” said Dr. Brenda Gati Mirembe of Uganda’s MU-JHU Research Collaboration, “I appreciated the fact that the Zambia team was willing to listen to researchers from countries that took part in ring studies.”

Calling the Uganda cohort “pioneers,” Mr. Ngoma called for united action to advocate for the PrEP ring. “We have to move as an army,” he said. “We must speak with one voice with scientific evidence. Numbers equal power – we need to move together. The workshop laid that foundation.”

 Advocates, ring researchers, and a PrEP ring user gathered in Lusaka, Zambia for an advocacy workshop in May 2021 to strategize and plan for ring introduction in the country.
Advocates, ring researchers, and a PrEP ring user gathered in Lusaka, Zambia for an advocacy workshop in May 2021 to strategize and plan for ring introduction in the country.
Photo credit: Featherstone Mangunje, FHI 360 Zambia
 Attendees got a chance to see and touch a dummy PrEP ring at the workshop which helped to familiarize advocates with its shape, texture, and size.
Attendees got a chance to see and touch a dummy PrEP ring at the workshop which helped to familiarize advocates with its shape, texture, and size.
Photo credit: Featherstone Mangunje, FHI 360 Zambia

Last updated: September 10, 2021

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