The Children’s Investment Fund Foundation (CIFF) has teamed up with the Global Fund to Fight AIDS, Tuberculosis and Malaria to unveil a new initiative.
Announced on July 21, 2024, during the 25th International AIDS Conference, this initiative will allocate up to $2 million for the procurement of around 150,000 dapivirine vaginal rings.
These rings will be distributed in countries that are utilizing Global Fund grants to combat HIV and AIDS during the 2024-2025 period.
The PrEP ring represents a long-lasting option for HIV pre-exposure prophylaxis (PrEP) specifically for women.
In 2022, there were 1.3 million new HIV infections, highlighting the significant gap in efforts to eliminate HIV and AIDS by 2030.
That is why it is essential to broaden access to PrEP and other preventive measures, while also enhancing treatment availability and viral load management, to effectively prevent new infections and disrupt the transmission cycle.
The design of the PrEP ring aims to lower the risk of HIV acquisition for women during sexual intercourse.
“The PrEP ring gives women and girls a discrete option that is entirely within their control,” says Miles Kemplay, the Executive Director, Sexual and Reproductive Health and Rights (SRHR), CIFF.
“For too long price points have made this option inaccessible; this partnership is the first step in making the market more sustainable and increasing access for those who need it,” he notes.
The PrEP ring is manufactured by Sever Pharma Solutions in Sweden for the Population Council.
A next-generation PrEP ring lasting three months will soon be under regulatory review.
The collaboration between CIFF and the Global Fund, set to commence in October, is designed to facilitate the early introduction of products to stimulate market demand for the PrEP ring.
Working alongside various partners, including Unitaid, the initiative also seeks to address the transition to a more affordable three-month PrEP ring and/or a PrEP ring manufactured in Africa, which is expected to result in reduced long-term pricing. Currently, the one-month ring is priced at US$12.8 per month. The newly announced initiative aims to pave the way for the three-month PrEP ring, anticipated to be priced below US$16, not including distribution costs, which would represent a nearly 60% reduction in monthly expenses.
Additional opportunities for further price decreases have been identified and are under consideration.
The partnership between CIFF and the Global Fund, which will kick off in October, aims to support early product introduction to seed the market for wider adoption of the PrEP ring.
In collaboration with other partners, including Unitaid, it also aims to bridge the gap to a lower-cost, three-month PrEP ring and/or an African-manufactured PrEP ring, which will lead to lower prices over the long-term.
The one-month ring currently costs US$12.8/month of use.
The initiative announced will create a bridge to the three-month PrEP ring, which will cost less than US$16, excluding distribution, representing a nearly 60% drop in price per month.
Several opportunities for further price reductions have been identified and are being explored.
“In many areas of the world, the rate of new HIV infections among adolescent girls and young women is more than three times the rate among adolescent boys and young men,” Peter Sands, the Executive Director of the Global Fund notes.
“This is unacceptable. We are convinced that this new PrEP ring can have a revolutionary impact. Girls and women have spoken up that they want the PrEP ring, and today’s announcement is one more steppingstone in a series of innovative approaches to give it to them,” he adds.
Bríd Devlin, Chief Scientific Officer at the Population Council’s Center for Biomedical Research, applauded CIFF and the Global Fund for their continued commitment to purchasing DapiRing.
He stresses that it is critical that women are offered a range of HIV prevention methods, including DapiRing, to meet their diverse sexual health needs and to use on their own terms. “Providing women with choice in HIV prevention is the best way to end the AIDS epidemic,” he added.
Expanding the range of HIV prevention methods, such as the PrEP ring, is a primary objective of advocacy organizations and an essential element of the HIV Prevention Choice Manifesto for Women and Girls in Africa.
The ring represents a groundbreaking advancement as the first long-acting prevention method to receive approval, especially beneficial for women and adolescent girls.
According to Yvette Raphael, Executive Director of Advocacy for the Prevention of HIV and AIDS (APHA) in South Africa and Chair of the African Women Prevention Community Accountability Board, these groups frequently face challenges in negotiating condom use and may find the daily regimen of oral PrEP to be too conspicuous.\
“It gives women and girls another option to choose from. HIV prevention choice is very important, and making the ring available for young women is our duty,” she said.
Since last year, the Global Fund has enabled procurement of the PrEP ring in Cambodia, Eswatini, Ghana, Indonesia, Mozambique, Uganda and South Africa.
Procurement in Mozambique and Uganda was supported in part by CIFF’s PrEP Matching Fund.
The next few years will be revolutionary for HIV prevention.
Post-exposure prophylaxis (PEP) is gaining increased recognition, and the World Health Organization (WHO) is set to unveil new guidelines on this topic at the International AIDS Conference.
“The Global Fund is committed to drive equitable access to quality assured and affordable HIV prevention tools and is working with partners and the industry to shape and create a sustainable market, including injectable lenacapavir,” said Hui Yang, Head, Supply Operations at the Global Fund.
The PrEP ring has received a positive opinion from the European Medicines Agency (EMA).
Regulatory authorities in Botswana, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, South Africa, Uganda, Zambia, and Zimbabwe have granted approval for the PrEP ring, while additional countries currently have regulatory submissions pending review.
The World Health Organization has endorsed the PrEP ring since 2021 as an alternative prevention option for women at high risk of HIV infection, integrating it into a comprehensive prevention strategy.
“There’s a lot of excitement and work to do to make sure that we shorten introduction timelines and support equitable access to these products in order to achieve the 2030 targets,” said Vuyiseka Dubula, Head of Community, Rights and Gender at the Global Fund.
The Global Fund and CIFF have partnered to fight HIV since 2015, when CIFF pledged US$10 million to support pediatric HIV treatment and expand access to treatment in Zimbabwe and Kenya.
In 2019, CIFF and the Global Fund launched a US$25 million catalytic investment to scale up access to HIV self-tests in Cameroon, Mozambique, Nigeria, Tanzania and Uganda.
In 2022, CIFF pledged US$33 million to the Global Fund to support accelerated access to PrEP and PEP for populations that need it most in Kenya, Mozambique, Nigeria, South Africa, Uganda and Zambia.
CIFF is an independent philanthropic organization with offices in Addis Ababa, Beijing, London, Nairobi and New Delhi. Established in 2002, CIFF works with a wide range of partners to create a healthy, fair and safe world for children.
Areas of work include child health and nutrition, sexual and reproductive health and rights, opportunities for girls and young women, child protection, and catalyzing climate action.
