PrEP-Pod-IVR (TDF-FTC/Placebo IVR 28 Day Crossover Study)

Inclusion Criteria:

1. Age of 18 through 45 years at screening, verified per site SOP

2. Female participants, born female

3. Not pregnant or breastfeeding

4. Availability to return for all study visits, barring unforeseen circumstances

5. Willing and able to

- communicate in English

- provide written informed consent to take part in the study

- provide adequate locator information, as defined in site SOP

- complete all required study procedures, including phone surveys, daily vaginal
swabs, and reliably store swabs in freezer

6. Must agree

- not to participate in other concurrent interventional and/or drug trials

- to use study-provided condoms for vaginal or anal intercourse for the duration of
the study

- to abstain from use of any vaginal products (e.g., lubricants, feminine hygiene
products, vaginally administered contraceptive products, sex toys) other than
study products for the duration of the study beginning at enrollment Note:
Tampons may be used during menses, but must be discontinued 72 hours prior to
study visits and for 7 days after biopsy procedures. Menstrual pads will be
provided to participants.

- to abstain from receptive oral, vaginal, or anal intercourse during the first
week after each pod-IVR insertion and for 2 days before and 7 days after biopsy
procedures

- to abstain from insertion of anything in the vagina (e.g., tampon, finger, sex
toy, lubricants, medication, douche) during the first week after each pod-IVR
insertion and for 2 days before and 7 days after biopsy procedures

7. Understands and agrees to local STI reporting requirements

8. HIV-1 seronegative at screening

9. Must be in general good health in the opinion of the investigator

10. Regular menstrual cycles of approximately 21 to 35 days apart with no untreated
intermenstrual menstrual bleeding Note: This criterion is not applicable to
participants using continuous combination oral contraceptive pills or progestin-only
methods (such as Depo-Provera or levonorgestrel-releasing IUD), as the absence of
regular menstrual cycles is an expected, normal consequence in this context.

11. Satisfactory cervical Pap result in the 36 calendar months prior to Enrollment
consistent with Grade 0 according to the Female Genital Grading Table for Use in
Microbicide Studies [Addendum 1, Dated November 2007], or if Grade 1 or higher Pap
result has had a satisfactory evaluation with no treatment required per American
Society for Colposcopy and Cervical Pathology (ASCCP) guidelines in the 12 calendar
months prior to Enrollment

12. Using an effective method of contraception and intending to continue use of an
effective method for the duration of study participation. Acceptable methods include:

- hormonal methods (except contraceptive vaginal rings)

- IUD

- sterilization of participant or partner

In addition to the criteria listed above, participants who agree to have rectal
biopsies collected must meet the following criteria:

13. Must agree to abstain from insertion of anything in the rectum (e.g., finger, sex toy,
lubricants, medication, enema) during the first week after each pod-IVR insertion and
for 2 days before and 7 days after biopsy procedures

Male sexual partner(s) who meet the following criteria are eligible for inclusion in the
study:

1. Age of 18 years or over

2. Has a female sexual partner enrolled in the study

3. Willing and able to

- communicate in English

- provide written informed consent to take part in the study

- provide adequate locator information, as defined in site SOP

- complete in-depth interview via video conference

Exclusion Criteria:

Individuals who meet any of the following criteria will be excluded from the study:

1. Undergoing or completed gender reassignment

2. Participant reports any of the following at Screening:

1. Has plans to relocate away from the study site area during the period of study
participation

2. Pregnant, less than 3 months post-partum, or lactating

3. Intends to become pregnant during the period of study participation

4. Current or planned use of an IVR

5. Known HIV-infected partners

6. Non-therapeutic injection drug use in the 6 months prior to screening

7. History of autoimmune disease

8. History of toxic shock syndrome

9. History of adverse reaction to TDF, FTC, silicone, or microcrystalline cellulose

10. PrEP or Post-exposure prophylaxis for HIV exposure within 6 months prior to
screening

11. Use of systemic immunomodulatory medications within the 4 weeks prior to the
Enrollment

12. Use of vaginally or rectally administered medications or products (including
condoms) containing Nonoxynol-9 (N-9) within the 4 weeks prior to the Enrollment

13. Participating in another research study involving drugs or medical devices within
the 4 weeks or 5 half-lives (if known) prior to the Enrollment

14. Gynecologic or genital procedure (e.g., tubal ligation, dilation and curettage,
piercing) within 60 days prior to Enrollment

Note: Colposcopy and cervical biopsies for evaluation of an abnormal Pap smear as well
as IUD removal are not exclusionary

3. Per participant report at screening, anticipated use and/or unwillingness to abstain
from the following medications during the period of study participation:

1. Heparin, including Lovenox® (enoxaparin sodium)

2. Warfarin

3. Plavix® (clopidogrel bisulfate)

4. Any other drugs that are associated with increased likelihood of bleeding
following mucosal biopsy (e.g., daily high dose aspirin, Pradaxa®)

5. NSAID use for 5 half-lives prior to biopsy (e.g. ibuprofen for 1 day, naproxen
for 4 days).

6. Rectally or vaginally administered medications (including over-the-counter
products)

4. History of significant gastrointestinal bleeding in the opinion of the investigator

5. Abnormalities of the cervical, vaginal, or colorectal mucosa, or significant
symptom(s), which in the opinion of the clinician represents a contraindication to
protocol-required biopsies (including but not limited to presence of any unresolved
injury, infectious or inflammatory condition of the local mucosa, and presence of
symptomatic external hemorrhoids). Erythema is not exclusionary.

• Includes any clinically apparent Grade 2 or higher pelvic examination finding
(observed by study staff) at Screening or Enrollment, as per the Female Genital
Grading Table for Use in Microbicide Studies [Addendum 1, Dated November 2007]

6. At screening: participant-reported symptoms and/or clinical or laboratory diagnosis of
active rectal or reproductive tract infection requiring treatment per current CDC
guidelines or symptomatic urinary tract infection (UTI). Infections requiring
treatment include symptomatic bacterial vaginosis, symptomatic vaginal candidiasis,
trichomoniasis, chlamydia (CT), gonorrhea (GC), syphilis, active HSV lesions,
chancroid, pelvic inflammatory disease, genital sores or ulcers, cervicitis, or
symptomatic genital warts requiring treatment (i.e., those that cause undue burden or
discomfort to the participant).

Note:

- An HSV-1 or HSV-2 seropositive diagnosis with no active lesions is allowed, since
treatment is not required

- One re-screening after documented treatment will be allowed

7. Has any of the following laboratory abnormalities at Screening:

Note: Grade is per Version 2.1 of the DAIDS Toxicity Table

1. Hemoglobin Grade 1 or higher

2. Platelet count Grade 1 or higher

3. International Normalized Ratio (INR) Grade 2 or higher

4. White blood cell count Grade 2 or higher

5. Calculated creatinine clearance ≤ 80 mL/minute using the Cockcroft-Gault equation

6. Grade 2 or higher ALT and/or AST (i.e., ≥ 2.5x the site laboratory upper limit of
normal [ULN])

7. Positive for Hepatitis B surface antigen (HBsAg)

8. Positive for Hepatitis C antibody (HCV Ab)

8. Has any other condition that, in the opinion of the Principal Investigator or
designee, would preclude informed consent, make study participation unsafe, complicate
interpretation of study outcome data, or otherwise interfere with achieving study
objectives

Male sexual partner(s) who meet the following criteria are not eligible for inclusion in
the study:

1) Female partner did not utilize study product