- A company headquartered in Johannesburg will start making flexible silicone rings to protect women from HIV.
- The move signals a strong vote of confidence in an African firm to supply the ring at adequate scale and affordable prices, and a crucial step to making the continent self-reliant.
- the price of the ring was still unknown, but it is expected to be lower than the current price of the Swedish-manufactured DapiRing.
A South African company has secured the rights to manufacture a vaginal ring used to prevent HIV infection.
The ring, which is inserted and removed by the user, provides protection for a month, after which it must be replaced with a new ring.
The ring contains an antiretroviral drug called dapivirine.
While studies show the dapivirine vaginal ring is less effective at preventing HIV than HIV prevention pills and injections, it has benefits over other tools that have led the World Health Organization (WHO) to recommend its inclusion in the package of sexual health services available to women.
One advantage of the ring over HIV prevention pills is it can be used discreetly by women, allowing users to use the ring without having to negotiate or discuss its use and purpose with their sexual partners.
This is particularly important in the context of South Africa where women face high rates of gender-based violence, which erodes their autonomy over their bodies and sexual and reproductive health.
“We need to give women more control over their health and bodies and access to a range of safe and effective options, including the dapivirine ring, to choose from so they can decide to use what works best for them at different times of their lives,” wrote several prominent female African activists in 2022.
While the WHO recommended the ring is offered to women, its current price is a barrier to broad use and rollout in South Africa.
The only dapivirine vaginal ring approved by the SA Health Products Regulatory Authority that is currently available in the country is called the DapiRing.
The DapiRing is manufactured by a Swedish company, Sever Pharma Solutions, under a licence from the Population Council (formerly the International Partnership for Microbicides).
It can be bought in South Africa’s private sector for R320, excluding dispensing fees.
The DapiRing is not available in South Africa’s public sector outside of study and pilot sites, as the National Essential Medicines List Committee, the body that determines which health technologies should be available in the country’s public health facilities, determined the product is unaffordable at its current price.
They estimate the product will become affordable for South Africa’s public sector at a threshold price of R52 per ring.
Local company to boost access
The Population Council, the entity that owns the intellectual property on the dapivirine vaginal ring, selected South African pharmaceutical company Kiara Health to manufacture and supply the ring across Africa.
Kiara Health’s CEO, Dr Skhumbuzo Ngozwana, told Spotlight while it was not yet known what the price of the Kiara manufactured ring would be, it was expected to be lower than the current price of the Swedish-manufactured DapiRing.
License to manufacture
The council told Spotlight the initial focus of the license and partnership would be to develop manufacturing capacity at Kiara Health to supply the dapivirine vaginal ring across Africa.
In the long term it is hoped Kiara will be able to serve markets outside of Africa where there is a need for the ring.
The Population Council’s selection of an African-based manufacturing partner is notable as holders of intellectual property protections on HIV health technologies have typically sought out companies in Asia, and India in particular, as manufacturing partners.
The CEO of the Desmond Tutu HIV Foundation, Professor Linda-Gail Bekker, told Spotlight: “If the Covid-19 pandemic taught us anything, it is the value of being self-reliant as a region – being able to manufacture the vaginal ring is a step closer to southern African self-reliance.”
Ngozwana said Kiara Health appreciated the Population Council bucked the trend by not going to the East.
“[A]ll these new technologies tend to go to the East, but instead they’ve partnered with an African company.”
He added future technology transfers to other manufacturers in Africa might be pursued if there was a need.
Exclusive supply license
The council told Spotlight it intended to pursue an exclusive supply licence with Kiara Health for the sole supply of the dapivirine ring in Africa.
The pursuit of an exclusive supply licence is a strong vote of confidence by the Population Council in the ability of Kiara Health to supply the ring at adequate scale and affordable prices.
Since Kiara Health’s exclusivity is for the supply of the ring, if there is a need, the company will be able to supply a dapivirine vaginal ring that is made by the Population Council’s Swedish manufacturing partner, Sever Pharma Solutions, that is already widely authorised for use in countries in Africa.
This would also guard against supply shortfalls that sometimes occurred when only one manufacturer supplied a market, Dr Brid Devlin, the Population Council’s chief scientific officer, told Spotlight.
“We would have two registered manufacturers right out the gate to guard against any shortfalls and have the opportunity to continue the supply as the demand grows.”
