Making the case for multipurpose prevention technologies: the socio‐epidemiological rationale

Boonstra, H; Barot, S; Narasimhan, Manjulaa

doi:10.1111/1471-0528.12851

Cited by 19 publications

(16 citation statements)

References 5 publications

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“…Multipurpose prevention technologies (MPTs) are biomedical interventions with more than one indication, such as prevention of HIV and unintended pregnancy‐ preferably in one formulation . 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 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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IntroductionPreventing HIV and unintended pregnancies are key global health priorities. To inform product rollout and to understand attributes of future multipurpose prevention technologies (MPT) associated with preference and use, we evaluated three placebo delivery forms: daily oral tablets, a monthly vaginal ring, and two monthly intramuscular injections in TRIO, a five‐month study among young Kenyan and South African women.Methods HIV‐negative, sexually active, non‐pregnant women aged 18 to 30 were enrolled and randomized to use each placebo delivery form for one month (stage 1). Then, participants chose one product to use for two additional months (stage 2). We assessed safety, product ranking, choice, and use. We examined demographic and behavioural correlates of choice and, reciprocally, unwillingness to use in the future with logistic regression models.Results277 women enrolled, 249 completed stage 1 and 246 completed stage 2. Median age was 23 years, 49% were Kenyan and 51% were South African. Three participants became pregnant during the study and one participant HIV‐seroconverted. There were 18 product‐related adverse events, six tablets‐related, 11 ring‐related, and one injection‐related. After trying each product, 85% preferred a TRIO product over condoms. Injections were chosen most (64%, 95% confidence interval (CI) 58%, 70%; p < 0.001), and by more South Africans than Kenyans (odds ratio (OR) 2.01, 95% CI: 1.17, 3.43; p = 0.01). There was no significant difference in choosing tablets versus ring (21%, 95% CI: 16%, 26% vs. 15%, 95% CI: 11%, 20%; p = 0.11). Tablet and ring adherence, based on direct observations and self‐reports, improved over time. However, participants’ self‐reported use of tablets did not match objective data from the electronic dose monitoring device. Participants were fully compliant with injections.ConclusionIn this population at risk for HIV and pregnancy, all participants agreed to choose and use a placebo MPT delivery form. A majority of participants preferred TRIO products to male condoms, an existing MPT. Injections were most liked and best used, however, they are years away from reaching the clinics. In the meantime, expanding the availability of tablets and giving access to rings can begin to fulfill the promise of choice for HIV prevention technologies and inform the development of suitable delivery forms as MPT.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…vaginal and/or anal), women require near perfect adherence to a seven day regimen, where MSM may reach adequate levels in anal tissues with only 4 days of pill taking in a week which can be non consecutive [ 14 , 15 ]. Because of the significant behaviour requirements to maintain consistent daily pill taking, additional options for PrEP delivery, including long-acting injectables, vaginal rings and films, are being developed to increase the selection of PrEP products and allow people to make choices about which technology best fits their lifestyles [ 22 – 24 ]. This scope of development is comparable to contraception where increasing the number of contraceptive options has been shown to significantly increase the overall uptake of contraception [ 25 ].…”

Section: Prep: Where Are We Now?mentioning

confidence: 99%

Pre-exposure prophylaxis (PrEP) in an era of stalled HIV prevention: Can it change the game?

2018

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Pre-exposure prophylaxis (PrEP) for HIV prevention has evolved significantly over the years where clinical trials have now demonstrated the efficacy of oral PrEP, and the field is scaling-up implementation. The WHO and UNAIDS have made PrEP implementation a priority for populations at highest risk, and several countries have developed guidelines and national plans accordingly, largely based on evidence generated by demonstration projects. PrEP presents the opportunity to change the face of HIV prevention by offering a new option for protection against HIV and disrupting current HIV prevention systems. Nevertheless, as with all new technologies, both practical and social requirements for implementation must be taken into account if there is to be sustained and widespread adoption, which will also apply to forthcoming prevention technologies. Defining and building success for PrEP within the scope of scale-up requires careful consideration. This review summarises where the PrEP field is today, lessons learned from the past, the philosophy and practicalities of how successful programming may be defined, and provides perspectives of costs and affordability. We argue that a successful PrEP programme is about effective intervention integration and ultimately keeping people HIV negative.

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“…To make significant advancement in the MPT field, the changing SRH needs of women throughout their life cycles, and in different regions of the world, must be considered . Until recently, funding programmes for HIV prevention research, as well as contraceptive research, have not adequately considered the socio‐behavioural and marketing aspects integral to the successful public health impact of such prevention products.…”

Section: Products For Diverse and Changing Target Populationsmentioning

confidence: 99%

“…To make significant advancement in the MPT field, the changing SRH needs of women throughout their life cycles, and in different regions of the world, must be considered. 14 [15][16][17] Hence, MPT product development must focus not only on what is necessary for technical feasibility and regulatory licensure, but also on the target market perspective, which includes a complex array of opinions from product users, healthcare providers, government ministries and procurement organisations. As in the case of specific technical product parameters, it will also be necessary to define user preference and other commercialisation targets before phase 3 trials.…”

Section: Products For Diverse and Changing Target Populationsmentioning

confidence: 99%

Ensuring successful development and introduction of multipurpose prevention technologies through an innovative partnership approach

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Manning

et al. 2014

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Making the case for multipurpose prevention technologies: the socio‐epidemiological rationale

Cited by 19 publications

References 5 publications

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

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

Pre-exposure prophylaxis (PrEP) in an era of stalled HIV prevention: Can it change the game?

Ensuring successful development and introduction of multipurpose prevention technologies through an innovative partnership approach

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