Interest in multipurpose prevention of HIV and pregnancy: perspectives of women, men, health professionals and community stakeholders in two vaginal gel studies in southern Africa

Abstract

Objective The pipeline of vaginal microbicides for HIV prevention has expanded to include products for multipurpose prevention, but the interests of potential users and those advising on use have not been sufficiently investigated. Rather, assumptions about interest in multipurpose prevention technologies (MPTs) are inferred from what is known about acceptability and use of microbicides or contraceptives.Design and setting This paper presents data on concerns and preferences for multipurpose prevention of HIV and pregnancy. Data were collected in two microbicide gel studies in Malawi and Zimbabwe. Participants were women using candidate vaginal products, their male partners, health professionals and community stakeholders.Methods An individual interview was conducted with participants. Interviews were audio-recorded, transcribed, coded for content and analysed for key themes.Results Participants indicated strong interest in a vaginal HIV prevention product that could also prevent pregnancy. Reasons for this interest were convenience, problems with adverse effects with current contraceptive methods, concerns about long-term effects of contraceptives, and concerns about the health burdens of HIV infection during pregnancy. The main disadvantage of an MPT was recognition that while interest in preventing HIV is constant, contraceptive needs change over time.Conclusion The study population indicated support for an MPT to prevent HIV and pregnancy. This support may be further strengthened if the product is also available for prevention of only HIV. Women and men will be more willing to use an MPT if they can be reassured that its use will have no long-term effect on fertility.

Microbicide vaginal rings: Technological challenges and clinical development

“…As a result, a raft of new ring designsstill largely based around silicone elastomer, EVA and TPU materials (see Section 2.3)has emerged aimed at overcoming this permeation barrier, including segmented matrix, multi-core, segmented reservoir, rod/tablet insert, core-matrix and pod insert rings ( Figure 2). A major impetus for continued innovation in ring design has been the growing interest in combination microbicide [45] and multipurpose prevention technology products [46][47][48][49] (see Section 2.8), for which release characteristics need to be individually tailored for each drug molecule. The release mechanisms that govern these new designs are discussed in Section 2.4.…”

Antiretrovirals for Primary HIV Prevention: the Current Status of Pre- and Post-exposure Prophylaxis

“…Interviews with African women participating in HIV prevention trials demonstrated substantial interest in using multipurpose products [90]. Ideally, multiple approaches to delivering PrEP will be efficacious and manufactured for public use, including topical, oral and injectable formulations, so that prevention options may be individualized based on each person’s sexual behaviors, patterns of exposure, and personal preferences.…”

The Tablets, Ring, Injections as Options (TRIO) study: what young African women chose and used for future HIV and pregnancy prevention

“…An MPT that combines HIV and pregnancy prevention could offer several advantages over two single‐indication products: it may improve motivation to use and acceptability by bundling a more common outcome (pregnancy) with a rarer and more stigmatized one (HIV), it simplifies use with potential adherence optimization, and it may also decrease burden on local health systems . Research so far has shown that African women overwhelmingly favor an MPT . However, well‐known challenges associated with condom, an existing MPT, (e.g.…”