...European Medicines Agency expands dapivirine vaginal ring recommendation to include girls aged 16+, offering new hope for HIV prevention in sub-Saharan Africa.
By Bunmi Yekini
The Population Council has announced a major milestone in the fight against HIV: the dapivirine vaginal ring (DVR), a monthly HIV prevention method, is now recommended for use by adolescent girls aged 16 years and older. The expanded recommendation, issued by the European Medicines Agency (EMA), significantly broadens access to the DVR, previously limited to women aged 18 and above.
The DVR, developed by the International Partnership for Microbicides (IPM) and now managed by the Population Council, is a flexible silicone ring inserted into the vagina, which releases the antiretroviral drug dapivirine over the course of a month. Clinical trials have shown the DVR can reduce the risk of HIV acquisition by approximately 30%, with higher effectiveness—up to 62%—observed in real-world follow-up studies like HOPE and DREAM.
“To truly stop the epidemic, countries must address the broader social and economic forces—like the scourge of gender-based violence, stigma, and limited healthcare access—that continue to drive new infections,” said Leonard Solai, Country Director and Global Access and External Affairs Lead at IPM South Africa. “The approval and increasing availability of the DVR marks a powerful step forward in HIV prevention for adolescent girls and young women in sub-Saharan Africa. This access is critical, but alone is not enough.”
The expanded EMA recommendation is based on data from the REACH study (MTN-034), a landmark trial conducted in South Africa, Uganda, and Zimbabwe. Funded by the U.S. National Institutes of Health, the study enrolled girls aged 16 to 21 and found that two-thirds of participants preferred the DVR over daily oral pre-exposure prophylaxis (PrEP), opting to continue with it beyond the study period.
“Daily oral PrEP is the HIV prevention option most broadly available for African women at risk of HIV,” said Dr. Sharon Hillier of the University of Pittsburgh School of Medicine. “In the REACH study, we found that the dapivirine vaginal ring was preferred 2 to 1 over oral daily PrEP. Extension of the EMA recommendation to age 16 provides an HIV prevention option that young women like and can use consistently.”
The move comes at a critical time. In 2023, 77% of adolescent girls and young women who acquired HIV lived in sub-Saharan Africa. Their HIV prevalence remains over three times that of their male peers.
“Adolescent girls are an important population who need and deserve protection from HIV infection,” said Prof. Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation. “Offering a method they like and can control themselves means they will be able to do so more effectively, safely, and consistently.”
To date, the DVR has been approved in 12 African countries, with more regulatory decisions pending. The World Health Organization also recommends the ring as part of the global HIV prevention toolkit.
This milestone marks not just a scientific advancement, but a celebration of choice—empowering adolescent girls with more control over their health and futures in regions hardest hit by the HIV epidemic.