How local realities guide PrEP Ring adoption

Women in sub-Saharan Africa, particularly adolescent girls and young women, continue to be disproportionately affected by HIV. To counter this, pre-exposure prophylaxis (PrEP) offers a powerful prevention strategy, providing individuals who are HIV-negative with a way to protect themselves from the virus.

Genesis is applying human-centred design (HCD) to expand women’s HIV prevention choices as part of a programme led by IPM South Africa NPC, an affiliate of the Population Council, for Grand Challenges Canada. IPM is the project lead, and responsible for strategic guidance and coordination.

The programme supports the market introduction of the 1-month dapivirine vaginal ring, or PrEP ring, for HIV prevention.Through co-creation workshops in Botswana and Rwanda, the programme is supporting PrEP ring introduction, ensuring service delivery and communications strategies align with the needs of end-users and healthcare providers.

The PrEP ring, a discreet and self-administered option, significantly enhances the HIV prevention toolkit, complementing new methods such as injectable PrEP (Lenacapavir and Cabotegravir). As a long-acting, user-controlled method, the PrEP ring expands choice and autonomy, enabling women to select protection that aligns with their lifestyle. By expanding the range of available options, the PrEP ring makes prevention more adaptable and accessible - a key step in empowering women’s health decisions.

The unseen barriers

Through our long-standing collaboration with IPM South Africa NPC and similar clients introducing new products, we have learned that simply making an innovative product available does not guarantee its successful adoption. The path to effective use is paved with complex social, cultural, and systemic considerations that extend beyond the product itself. For instance, barriers can include the burden of daily pill-taking associated with oral PrEP regimens, as well as general hesitancy around new health interventions, such as that seen with vaccine uptake. 

We also see issues with pre-existing stigma around HIV and prevention methods, cultural norms about women inserting objects into their bodies, negative perceptions from partners, and the attitudes and knowledge of healthcare providers themselves. These nuances must be addressed to ensure a product is not only accessible but also acceptable.

The 'inside-out' approach

The progamme’s PrEP ring initiative employs an ‘inside-out’ approach through HCD, placing end-users' lived experiences at the heart of solution development. By engaging women at different stages of life (ages 18-45) and healthcare providers as co-creators in the Botswana workshops, the programme collaboratively designed service delivery models and communication tools that are both practical and reflective of community needs. This ensures the interventions are not just theoretically sound, but authentically rooted in the realities of those they serve.

The immersive workshops leveraged a rapid design sprint methodology to systematically address challenges in PrEP ring adoption. Participants first mapped barriers across the entire user journey, from initial awareness to sustained usage. They then engaged in a solution-focused ideation phase using "How Might We" questions. This process yielded concrete strategies including tailored social media campaigns with dedicated hashtags, locally adapted educational materials, and enhanced healthcare provider support mechanisms. Through iterative prototyping, these concepts were refined into practical tools, ensuring the solutions are grounded in the realities of end-users and healthcare systems.

The Genesis team will be facilitating the co-design and prototype workshops in Rwanda. This co-creation process ensures the PrEP ring's introduction is informed by the lived experiences of the communities in which it will be introduced. The resulting recommendations, shaped by women and healthcare providers themselves, strengthen HIV prevention programmes in Botswana and Rwanda by prioritising choice, accessibility and cultural relevance in public health implementation.