LAUSR

BACKGROUND Persistent use of HIV prevention methods can be a challenge, particularly for some younger women. The long-acting, discreet, woman-centric dapivirine vaginal ring offers promise as a prevention method with less user burden, which could support continued use. We assessed dapivirine vaginal ring use to understand adherence patterns and identify characteristics influencing patterns. SETTING Participants enrolled in South Africa in the MTN-020/ASPIRE randomized placebo-controlled trial. METHODS We used group-based trajectory modeling to identify clusters of participants with similar longitudinal patterns of adherence in last year of participation and potential predictors of group membership. Women with at least one year of follow-up were included (n=626). RESULTS Five adherence patterns were identified: (1) consistently high, 34%, (2) consistently moderate, 34%, (3) consistently low, 16%, (4) decreasing, 9%, and (5) increasing, 7%.Women <22 years (adjusted odds ratio [AOR] 1.8, 95% Confidence Interval [CI]: 1.0, 3.0), those using an intrauterine device [AOR 3.3, 95% CI: 1.4, 7.8] or oral contraceptives [AOR 3.9, 95% CI: 1.7, 8.9], experiencing menses [AOR 1.8, 95% CI: 1.1, 3.0] and who reported inconsistent condom use [AOR 1.8, 95% CI: 1.0, 3.3] were more likely to be classified as consistently low compared to consistently high. CONCLUSION Most South African women successfully persisted with moderate or high-level of use. Encouraging ring replacement with completion of menses may help to decrease concerns about hygiene and improve persistence. Associations between contraception and persistent low adherence suggest efforts may be needed to ensure contraceptive method choice does not interfere with ring use.