ASPIRE: A Study to Prevent Infection with a Ring for Extended Use

Making life-saving strides in HIV research and women’s empowerment

National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Mental Health

Microbicide Trials Network

ASPIRE, conducted by RTI, is the first trial to demonstrate the effectiveness of a long-acting microbicide (a dapivirine ring) for HIV prevention in women in South Africa.

More than half of the 24.7 million people living with HIV in Sub-Saharan Africa are women, and the highest mode of transmission is unprotected heterosexual sex. Unfortunately, studies have shown that many at-risk women are unable to consistently use new prevention options such as antiretroviral (ARV) gels and tablets.

ASPIRE included more than 2,600 HIV-free women ages 18-45 years who were at high risk for infection. Participating women received either the protective ring or an injection delivering dapivirine or a placebo ring or an injection. All study participants also received HIV prevention services at each study visit.

Overall, the study found the ring reduced the risk of HIV infection by 27 percent in the study population, but that results varied by age and adherence to ring use. Specifically, HIV infection was reduced by 56 percent for women 21 and older, whereas the risk for women ages 25 years and older, who used the ring most consistently, was reduced by 61 percent.

Our investigators co-authored a publication in the New England Journal of Medicine about the overall ASPIRE trial results.

The ASPIRE study is an important step towards determining whether the dapivirine ring could be a viable option for reducing HIV acquisition among women in Africa and around the globe. Ultimately, our research in support of the search for drug delivery devices that are acceptable and easy to use will help increase choices for women who need protection from HIV.