Aligning product development and user perspectives: social–behavioural dimensions of multipurpose prevention technologies

Brady, Martha; Tolley, Elizabeth E.

doi:10.1111/1471-0528.12844

Cited by 32 publications

(28 citation statements)

References 53 publications

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“…Additionally the best mix of indications may vary in different regions of the world based on local patterns of infections and contraceptive need as well as user-related social and behavioral dimensions [48]. Based on survey data collected, the Initiative for Multipurpose Prevention Technologies and the Coalition Advancing Multipurpose Innovations (IMPT/CAMI) propose sustained release devices (e.g., IVRs), long acting injectables, and on demand/pericoital products (e.g., films and gels) as the highest priorities (http://mpts101.org/mpt-database).…”

Section: Developing All In One Technologies To Target Multiple Stis Amentioning

confidence: 99%

Multipurpose prevention technologies: the future of HIV and STI protection

Fernández-Romero

Deal

Herold

et al. 2015

Trends in Microbiology

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Every day, more than 1 million people are newly infected with sexually transmitted infections (STIs) that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition. Existing prevention and management strategies, including behavior change, condom promotion, and therapy have not reduced the global incidence and prevalence, pointing to the need for novel innovative strategies. This review summarizes important issues raised during a satellite session at the first HIV R4P conference, held in Cape Town, on October 31, 2014. We explore key STIs that are challenging public health today; new biomedical prevention approaches including multipurpose prevention technologies (MPTs); and the scientific and regulatory hurdles that must be overcome to make combination prevention tools a reality.

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Section: Developing All In One Technologies To Target Multiple Stis Amentioning

confidence: 99%

Multipurpose prevention technologies: the future of HIV and STI protection

Fernández-Romero

Deal

Herold

et al. 2015

Trends in Microbiology

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“…Effective product positioning can increase demand by diverse users (Brady and Tolley 2014;Morrow and Ruiz 2008;Tolley et al 2014) and influence product user knowledge, acceptability and willingness to adopt new innovations. Research that explores the diversity of user needs and it relationship to product associations is crucial to advance the HIV prevention agenda, as women's HIV prevention options are often influenced by age, geo-spatial location and types of sexual encounters (Govender, Mansoor, and Abdool Karim 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Strategic demand creation that caters for these determinants will better position PrEP for high uptake and adherence (Terris-Prestholt et al 2013). Mapping user product preferences provides a nuanced perspective to the market segmentation of those who are likely to consider PrEP (Brady and Tolley 2014).…”

Section: Introductionmentioning

confidence: 99%

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

Govender

Mansoor

MacQueen

et al. 2017

Culture, Health & Sexuality

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The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada ® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around HIV prevention; and an increased desire for HIV protection. Findings reaffirm the influence of user engagement in understanding the sociocultural dynamics that influence demand creation for PrEP adoption.

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“…It is likely that more than one effective prevention option will be needed to achieve population coverage among women [10]. One option to increase impact while making products more desirable to potential users is to develop multi-purpose prevention technologies (MPTs), which simultaneously provide protection from two or more of HIV, other STIs and unintended pregnancy [11][12][13][14]. Current MPTs in development include: (1) long-acting drug delivery systems such as intravaginal rings, designed to protect from HIV infection and pregnancy (currently in phase-1 trial, ClinicalTrials.gov Identifier: NCT02235662); (2) pericoital drug delivery systems such as vaginal gels, tablets and films (not currently being trialled); and (3) co-provision of a combination of products, such as a contraceptive diaphragm with microbicide gel (currently feasible but not widely implemented) [11,15].…”

Section: Introductionmentioning

confidence: 99%

The cost‐effectiveness of multi‐purpose HIV and pregnancy prevention technologies in South Africa

et al. 2018

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IntroductionA number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi‐purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost‐effectiveness of combinations of candidate multi‐purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs).MethodsWe combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost‐effectiveness of five candidate co‐formulated or co‐provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end‐users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability‐adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis.ResultsAt central incidence rates, all single‐ and multi‐purpose scenarios modelled were cost‐effective among FSWs and women aged 16–24, at a governmental willingness‐to‐pay threshold of $1175/DALY averted (range: $214–$810/DALY averted among non‐dominant scenarios), however, none were cost‐effective among women aged 25–49 (minimum $1706/DALY averted). The cost‐effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters.ConclusionsTo the best of our knowledge, this is the first study to estimate the cost‐effectiveness of a range of potential MPTs; suggesting that MPTs will be cost‐effective among higher incidence FSWs or young women, but not among lower incidence older women. More work is needed to make attractive MPTs available to potential users who could use them effectively.

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Aligning product development and user perspectives: social–behavioural dimensions of multipurpose prevention technologies

Cited by 32 publications

References 53 publications

Multipurpose prevention technologies: the future of HIV and STI protection

Multipurpose prevention technologies: the future of HIV and STI protection

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

The cost‐effectiveness of multi‐purpose HIV and pregnancy prevention technologies in South Africa

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