An update on multipurpose prevention technologies for the prevention of HIV transmission and pregnancy

Abstract

There has been considerable advance in this field over the past three years. There is one ring currently in a Phase I clinical trial and others are soon to follow. Some of these drug delivery systems are by necessity rather complicated and hence could be prohibitively expensive in the developing world. Conducting multiple clinical trials to support regulatory approval of two or more indications represents a significant barrier. It remains unclear that women will be more motivated to use MPT products than has been observed in recent microbicide-only clinical trials. Despite these challenges, the need for MPTs remain acute hopefully ensuring they will continue to be developed over the coming years.

Residual hormone levels in used contraceptive rings as a measurement of adherence to vaginal ring use

“…Multipurpose vaginal rings and new contraceptive vaginal rings in development are building upon existing technology used in NuvaRing ® to improve and control compound release [3]. While the methodology may need to be amended to fit each new product, the testing approach presented here provides a basis for applying new analytical measures of vaginal ring adherence applicable to multipurpose vaginal rings and new contraceptive vaginal rings.…”

“…Measuring adherence to PrEP regimens has relied primarily on participant self-report that can be unreliable (e.g., overreporting, recall issues, social desirability) or blood ARV concentrations that may not provide accurate measures of cumulative drug exposure over extended periods of use [2]. HIV PrEP interventions currently in development include multipurpose vaginal rings containing ARVs to prevent sexual transmission of HIV in addition to hormonal contraceptives to prevent pregnancy [3]. New analytical approaches to assess adherence to multipurpose vaginal rings are needed to better evaluate the safety and efficacy of these new intervention strategies [2,4,5].…”

The promise of multipurpose pregnancy, STI, and HIV prevention

“…A vaginal ring is currently undergoing phase-I clinical trials with others soon to follow, whilst coadministration of contraceptive and HIV prevention products is also under consideration. [5] It certainly is time to take STIs seriously. Yet investments in attractive multipurpose products which meet a range of SRH needs could have more impact than vertical spending on STIs.…”

Levonorgestrel in contraceptives and multipurpose prevention technologies

“…Several MPT intravaginal rings containing a progestin plus an ARV for HIV prevention (such as tenofovir or dapivirine) or a combination of active ingredients (such as zinc acetate, carrageenan, and an ARV for simultaneous prevention of HIV, herpes simplex virus-2, and human papillomavirus) are in development. [4]…”