Multipurpose prevention technologies for sexual and reproductive health: gaining momentum and promise

Holt, Bethany Young; Kilbourne-Brook, Maggie; Stone, Alan; Harrison, Polly F.; Shields, Wayne C.

doi:10.1016/j.contraception.2009.11.009

Cited by 21 publications

(17 citation statements)

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“…Prevention strategies have mostly focused individually on prevention of unplanned pregnancy, prevention of other reproductive tract infections, and prevention of STIs. However, accumulating data indicate that these issues are linked, suggesting that a woman at risk for pregnancy is also at risk for contracting an STI or other reproductive tract infection [85]. Additionally, a certain stigma is associated with self-identifying as “high-risk” for HIV and STI, and most women are reluctant to do so, even those that are truly at high risk.…”

Section: Multipurpose Prevention Technologiesmentioning

confidence: 99%

“…Anti-infective and contraceptive microbicides could be developed in three ways based on utilizing a single drug with dual activity, a combination of a microbicidal compound with a contraceptive agent or a combination of a drug with a device. Relevant technologies do exist including male and female condoms to prevent pregnancy and STIs but they are not widely accepted [85, 88]. Recent advances in microbicide development have also provided a foundation for the development of other Multipurpose prevention products, including multipurpose IVRs and diaphragms with contraceptives and anti-STI microbicides [85, 89] and probiotics to treat and deliver drugs [85, 90], a successful product will likely be dependent on scientific innovation and persistence and will require a concerted scientific and financial effort between many organizations.…”

Section: Multipurpose Prevention Technologiesmentioning

confidence: 99%

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Factors Important to the Prioritization and Development of Successful Topical Microbicides for HIV-1

Buckheit

2012

Molecular Biology International

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Significant advancements in topical microbicide development have occurred since the prevention strategy was first described as a means to inhibit the sexual transmission of HIV-1. The lack of clinical efficacy of the first generation microbicide products has focused development attention on specific antiretroviral agents, and these agents have proven partially successful in human clinical trials. With greater understanding of vaginal and rectal virus infection, replication, and dissemination, better microbicide products and delivery strategies should result in products with enhanced potency. However, a variety of development gaps exist which relate to product dosing, formulation and delivery, and pharmacokinetics and pharmacodynamics which must be better understood in order to prioritize microbicide products for clinical development. In vitro, ex vivo, and in vivo models must be optimized with regard to these development gaps in order to put the right product at the right place, at the right time, and at the right concentration for effective inhibition of virus transmission. As the microbicide field continues to evolve, we must harness the knowledge gained from unsuccessful and successful clinical trials and development programs to continuously enhance our preclinical development algorithms.

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Section: Multipurpose Prevention Technologiesmentioning

confidence: 99%

Section: Multipurpose Prevention Technologiesmentioning

confidence: 99%

Factors Important to the Prioritization and Development of Successful Topical Microbicides for HIV-1

Buckheit

2012

Molecular Biology International

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“…Multipurpose Prevention Technologies (MPTs) are new prevention tools aimed at two or more SRH risks, including treatable STIs, HIV and unintended pregnancy (Holt, 2010). At present, male and female condoms are the most common and widespread MPT.…”

Section: Introductionmentioning

confidence: 99%

“…A number of other MPT approaches are currently being considered, including injectables that might be co-formulated or co-administered, vaginal and/or rectally-inserted gels, oral pills or devices including vaginal rings. One MPT currently in development is a one-month vaginal ring able to release a contraceptive progestin and an antiviral agent to reduce the risk of HIV (Holt, 2010). …”

Section: Introductionmentioning

confidence: 99%

Designing a multipurpose technology for acceptability and adherence

2013

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Multipurpose Prevention Technologies (MPTs) are new tools aimed at reducing or preventing multiple and overlapping sexual and reproductive health risks faced by women and couples around the globe. While MPTs could prove more acceptable and easier to adhere to than single-purpose prevention products, continuing high rates of HIV and unintended pregnancy remind us that these new products will need to be efficacious, acceptable and effectively used to achieve a public health impact. In this paper, we describe how a range of research methods can be applied during the pre-clinical phase of product development to inform decisions related to formulation and vehicle or product delivery mechanisms, and consider how choices in product-related characteristics may influence future demand for, delivery and use of future products. We draw on examples from the development of new single-purpose HIV and contraceptive products and then extend our discussion to the development of MPTs, including vaginal rings and injections. This article is based on a presentation at the “Product Development Workshop 2013: HIV and Multipurpose Prevention Technologies,” held in Arlington, Virginia on February 21-22, 2013. It forms part of a special supplement to Antiviral Research.

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“…Microbicides are chemical agents used intravaginally with a goal to protect users against sexually transmitted infections (STIs) including HIV [2]. Multipurpose prevention microbicides, also referred to as ‘combinations’, are in development which may provide protection from HIV, some sexually transmitted infections, as well as unplanned pregnancy and other reproductive tract infections [3]. They can be classified according to different mechanisms of action: non-specific microbicides, moderately specific microbicides, highly specific anti-HIV agents, etc [4].…”

Section: Introductionmentioning

confidence: 99%

Increasing the Effectiveness of Vaginal Microbicides: A Biophysical Framework to Rethink Behavioral Acceptability

2010

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BackgroundMicrobicide candidates delivered via gel vehicles are intended to coat the vaginal epithelium after application. The coating process depends on intrinsic biophysical properties of the gel texture, which restricts the potential choices for an effective product: the gel first must be physically synthesizable, then acceptable to the user, and finally applied in a manner promoting timely adequate coating, so that the user adherence is optimized. We present a conceptual framework anchoring microbicide behavioral acceptability within the fulfillment of the product biophysical requirements.MethodsWe conducted a semi-qualitative/quantitative study targeting women aged 18–55 in Northern California to assess user preferences for microbicide gel attributes. Attributes included: (i) the wait time between application and intercourse, (ii) the gel texture and (iii) the trade-off between wait time and gel texture. Wait times were assessed using a mathematical model determining coating rates depending upon the gel's physical attributes.Results71 women participated. Results suggest that women would independently prefer a gel spreading rapidly, in 2 to 15 minutes (P<0.0001), as well as one that is thick or slippery (P<0.02). Clearly, thick gels do not spread rapidly; hence the motivation to study the trade-off. When asked the same question ‘constrained’ by the biophysical reality, women indicated no significant preference for a particular gel thickness (and therefore waiting time) (P>0.10) for use with a steady partner, a preference for a watery gel spreading rapidly rather than one having intermediate properties for use with a casual partner (P = 0.024).ConclusionsBiophysical constraints alter women's preferences regarding acceptable microbicide attributes. Product developers should offer a range of formulations in order to address all preferences. We designed a conceptual framework to rethink behavioral acceptability in terms of biophysical requirements that can help improve adherence in microbicide use ultimately enhancing microbicide effectiveness.

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Multipurpose prevention technologies for sexual and reproductive health: gaining momentum and promise

Cited by 21 publications

References 10 publications

Factors Important to the Prioritization and Development of Successful Topical Microbicides for HIV-1

Factors Important to the Prioritization and Development of Successful Topical Microbicides for HIV-1

Designing a multipurpose technology for acceptability and adherence

Increasing the Effectiveness of Vaginal Microbicides: A Biophysical Framework to Rethink Behavioral Acceptability

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