Multipurpose Prevention Technologies: Opportunities and Challenges to Ensure Advancement of the Most Promising MPTs

Holt, Bethany Young; Turpin, Jim A.; Romano, Joseph

doi:10.3389/frph.2021.704841

Cited by 18 publications

(14 citation statements)

References 31 publications

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“…As our study findings rely on participant self-report, similar limitations should be highlighted in terms of social desirability and recall bias. Additionally, researchers assume that clinical trial patterns differ from "real world" behaviours and that adherence in clinical trials usually is as good or greater than "real life" adherence (16,18,23,54,55).…”

Section: Discussionmentioning

confidence: 99%

“…Multipurpose prevention technologies (MPTs) targeting combination(s) of HIV, other STIs, and unintended pregnancy are currently under development. MPTs, and especially long-acting MPTs, could be a game changer for many women and may improve adherence (5,8,(21)(22)(23). For example, studies have shown that many women perceive their risk of getting pregnant as higher than their risk of getting infected with HIV (16,24).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, contraceptive use is more normalized in most countries, and less controversial to discuss, than HIV prevention use (24). However, MPTs may also present new challenges; vaginal ring use for HIV prevention has to be continuous whereas vaginal ring use for contraception has historically been intermittent with a one week break to allow for menstruation (18,21,(23)(24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

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High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda

Kestelyn,

Van Nuil,

Umulisa

et al. 2024

Front. Glob. Womens Health

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BackgroundThe introduction of female-initiated drug-delivery methods, including vaginal rings, have proven to be a promising avenue to address sexually transmitted infections and unintended pregnancies, which disproportionally affects women and girls in sub-Saharan Africa. Efficient uptake of existing and new technologies such as vaginal rings requires in depth understanding of product adherence. This remains a major challenge as data on adherence to vaginal rings from African countries is limited. In this study, we explored adherence of contraceptive vaginal ring (NuvaRing®) use in Kigali, Rwanda using a mixed methods approach.MethodsWe collected quantitative and qualitative data at multiple time points from women participating in a clinical trial exploring the safety and acceptability of either intermittent or continuous use of the NuvaRing®. Various adherence categories were used including monthly and cumulative adherence measurement. The quantitative data were analysed using R and the qualitative data were analysed using a deductive, content-analytical approach based on categories related to the quantitative adherence measures. All data were compared and triangulated.ResultsData from 120 enrolled participants showed that self-reported adherence was high at every study visit in both study groups. At first study visit 80% of the intermittent ring users and 79.7% of the continuous ring users reported perfect adherence (assessed as “the ring was never out”). Reporting of ring expulsions and removals were highest (28.3%) at the beginning of the trial. Self-reported perfect ring adherence increased during the study and reports of ring expulsions and removals declined as familiarity with this contraceptive method increased. The percentage of women with perfect cumulative adherence was non-significantly higher in the intermittent (61.7%) than in the continuous use group (54.3%). The low rate of discrepant adherence data after triangulation (6%) is in line with the perception of the participants as adherent throughout the study.ConclusionsSelf-reported adherence in both study groups was high with removals and expulsions being within the expected product range. Comprehensive adherence data triangulation allowed for a deeper understanding of context-driven behaviour that shaped adherence patterns and challenges. Our data categorisation and triangulation approach has shown potential for implementation in future vaginal ring studies aiming to better understand and measure adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda

Kestelyn,

Van Nuil,

Umulisa

et al. 2024

Front. Glob. Womens Health

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“…A few AGYWs indicated their interest in a prevention method, preventing HIV and other STI's. Multipurpose prevention technologies (MPT) are prevention products that simultaneously offer protection against HIV, other STI's and/or unintended pregnancy ( 94 ). There is a growing array of MPT candidates in development ( 95 ).…”

Section: Discussionmentioning

confidence: 99%

Planning for decentralized, simplified prEP: Learnings from potential end users in Ga-Rankuwa, gauteng, South Africa

Mataboge

Nzenze²,

Mthimkhulu³

et al. 2023

Front. Reprod. Health

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BackgroundIn South Africa, youth experience challenges with oral Pre-Exposure Prophylaxis (PrEP) access and uptake. Taking services out of healthcare settings has the potential to increase reach and overcome these challenges. This paper presents young and older people's preferences for decentralized, simplified PrEP service delivery and new long-acting HIV prevention methods, in Ga-Rankuwa, South Africa.MethodsBetween May and August 2021, both PrEP user and non-user adolescent girls and young women (AGYW), pregnant AGYW, female sex workers, adolescent boys and young men (ABYM), and men who have sex with men (MSM) were recruited to participate in focus group discussions (FDGs) in Ga-Rankuwa, Gauteng. Twenty-two FGDs were conducted. Participants were asked about PrEP uptake, potential acceptability of long-acting HIV prevention products, provision of integrated, simplified, and decentralized services, and digital tools to facilitate access to PrEP and other SRH services. A qualitative approach using inductive thematic analysis was carried out to explore emerging themes on decentralized, simplified delivery and the acceptability of long-acting methods.ResultsOf the 109 participants included in the study approximately 45% (n = 50) were female, the median age was 23 years ± 5.3. A third (n = 37) were current or previous PrEP users, of which, 59.5% (n = 22) collected PrEP refills from the clinic. Decentralized, simplified service delivery was appealing; health facilities, pharmacies and institutions of learning were preferred as service points for PrEP and SRH services, and recreational spaces preferred for dissemination of health information and engagement. ABYM were more open to having recreational spaces as service points. Long-acting Cabotegravir was preferred over the Dapivirine Vaginal Ring due to concerns around perceived side-effects, efficacy, and comfort.ConclusionProviding long-acting PrEP methods through decentralized, simplified service delivery was appealing to this population. They provided practical locations for decentralized service provision to potentially increase their engagement with and uptake of HIV prevention and SRH services.

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“…While these efforts are underway to improve the introduction and scale up of currently or soon-to-be available HIV biomedical interventions, further work is needed to ensure future HIV prevention options meet women's varied needs including expanding choice by diversifying HIV prevention offering. Ongoing early development focuses on innovative combinations such as multipurpose technologies (MPTs), which aim to address the multiple needs of AGYW and others who are at risk for HIV, other STIs, and unwanted pregnancies ( 18 ). There are currently a number of MPTs in the pipeline such as oral pills, long acting injectables and implants with dual indication for HIV prevention and the prevention of unwanted pregnancies ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

The role of economic evaluations in advancing HIV multipurpose prevention technologies in early-stage development

Chapman,

Torres-Rueda,

Metzler

et al. 2024

Front. Reprod. Health

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Product development is a high-risk undertaking, especially so when investments are prioritized for low- and middle-income countries (LMICs) where markets may be smaller, fragile, and resource-constrained. New HIV prevention technologies, such as the dapivirine vaginal ring (DVR) and long-acting injectable cabotegravir (CAB-LA), are being introduced to these markets with one indication, meeting different needs of groups such as adolescent girls and young women (AGYW) and female sex workers (FSWs) in settings with high HIV burden. However, limited supply and demand have made their uptake a challenge. Economic evaluations conducted before Phase III trials can help optimize the potential public health value proposition of products in early-stage research and development (R&D), targeting investments in the development pathway that result in products likely to be available and taken up. Public investors in the HIV prevention pipeline, in particular those focused on innovative presentations such as multipurpose prevention technologies (MPTs), can leverage early economic evaluations to understand the intrinsic uncertainty in market characterization. In this perspective piece, we reflect on the role of economic evaluations in early product development and on methodological considerations that are central to these analyses. We also discuss methods, in quantitative and qualitative research that can be deployed in early economic evaluations to address uncertainty, with examples applied to the development of future technologies for HIV prevention and MPTs.

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Multipurpose Prevention Technologies: Opportunities and Challenges to Ensure Advancement of the Most Promising MPTs

Cited by 18 publications

References 31 publications

High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda

High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda

Planning for decentralized, simplified prEP: Learnings from potential end users in Ga-Rankuwa, gauteng, South Africa

The role of economic evaluations in advancing HIV multipurpose prevention technologies in early-stage development

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