In sub-Saharan Africa, adolescent girls and young women are at the highest risk of acquiring HIV. However, as this is a heterogeneous population, the characteristics of these women can vary greatly. A one-size-fits-all approach simply will not work. In order for MPTs to have the greatest impact, approaches must be tailored to the populations where they are most likely to be successful.
Happy New Year from the IMPT Secretariat!
Recharged from the holiday season, we are proud to share a few major highlights from our 2018 work as IMPT learning network manager – fostering connections between multidisciplinary partners; collecting, synthesizing, and disseminating MPT-relevant information; and accelerating action to advance progress in the field.
Every four minutes, three young women will become infected with HIV—that’s close to 900,000 new infections a year. While HIV prevention research and drug development have progressed rapidly, there is still work to be done. This World AIDS Day, we reflect on our work to advance MPTs by asking the IMPT Advisory Council for their perspective on the role of MPTs in the fight to end the HIV epidemic.
Earlier this year, we wrote a post about Target Product Profiles (TPPs) and the generalized versions that the IMPT developed in 2015 for two MPT product types. As we argue in that post, a product that meets all clinical targets listed in a TPP will not necessarily correlate to its public health impact in the real world. That is, not unless we work to understand what the future end-users of MPTs – who include both the women who will use MPTs to protect their sexual and reproductive health as well as the health providers who will prescribe MPTs for these women – want and need in a product and then integrate those learnings into the product development process. Of course, it is critical that an MPT be efficacious and safe, but how can we expand the product evaluation process to better ensure that future end-users will be able to access, want to try, and continue to use an MPT?
The field of MPTs that combine hormonal contraception (HC) and antiretroviral drugs for HIV prevention has made substantial progress in the past several years. There are two such MPTs in phase I clinical trials: 1) IPM’s dapivirine and levonorgestrel intravaginal ring and 2) CONRAD’s tenofovir and levonorgestrel intravaginal ring – with several other HC + ARV MPT products on the cusp in various stages of preclinical development.
Today, on World Sexual Health Day, we at the IMPT reflect on how to work with partners to improve sexual health across the globe. There are many things that could be done, many different approaches, and many people we can work with towards this goal. Here, at the IMPT, we see multipurpose prevention technologies (MPTs) to be one such promising strategy with the potential to improve the sexual health – and lives – of women and their families across the globe.
As a healthcare provider, your perspective matters in the movement to advance the field of multipurpose prevention technologies (MPTs). Physicians, nurses, community health workers, pharmacists, and other healthcare providers are critical “gatekeepers” of health products and information with their clients and in their communities, and thus they have a big impact on their patients’ health behaviors and outcomes. Fostering a trustworthy healthcare environment has been linked to increased comfort levels and better patient health, as well as increased medication adherence. You will be on the frontlines of ensuring the success of MPTs once they hit the market – giving patients access to such products and helping them with correct and consistent use.
We are pleased to announce the launch of the IMPT Advisory Council – a group tasked with providing strategic guidance for the IMPT network, with a particular emphasis on sustainability and new stakeholder engagement.
A critical function of the IMPT Secretariat is to serve as a knowledge manager for the MPT field. In this way, we collect and disseminate MPT-relevant resources, as well as synthesize data and stakeholder expertise into useful tools and frameworks in order to inform future work within the MPT field. While the IMPT Secretariat continues to develop new resources to meet the needs of an evolving field, we want to highlight a tool – originally developed in 2015 – that is still relevant to stakeholders in the MPT field today: generalized Target Product Profiles (TPPs) for intravaginal ring (IVR) MPTs and long-acting injectable MPTs.
At this point, we do not likely need to convince you that if you are aiming to develop and introduce an MPT product, incorporating end-user research into the process is a good idea, especially if you want it to have a positive public health impact. We at the IMPT Secretariat are delighted that end-user research has become an increased focus in the contraception, HIV prevention, and global health spaces. It is now critical that enthusiasm for end-user research in these fields is applied effectively – that is, employs the right methods with the right stakeholders during the right stages, asks questions that fill knowledge gaps rather than ‘reinvent the wheel,’ and otherwise addresses past challenges experienced with this type of research.
Since 2009, when MPTs officially became a “thing,” we have had a lot of conversations about MPTs and answered even more questions. We have spoken with friends, family, colleagues, neighbors, seatmates on plane flights – you name it. Until recently, not many people had heard of MPTs, and we spent a large part of these conversations doing quite a bit of explaining.
Most people we talk to seem universally on board with the concept of MPTs, thinking that it “just makes sense” as a prevention approach. However, because there aren’t many ready-to-use MPTs on the market (condoms being the sole exception) they are also hesitant to get “too excited” about future products still in development. For many, MPTs sound great – but intangible, disconnected from reality.
If you are an advocate for youth health and wellbeing, you need to know about multipurpose prevention technologies (MPTs) – innovative tools on the horizon to address a gap in the sexual and reproductive health of women and girls. It’s a long name, but there’s a reason behind that. First, these tools are called multipurpose prevention because they simultaneously protect against various combinations of HIV, other sexually transmitted infections (STIs) AND unintended pregnancy. Second, the add-on of technologies illustrates that the field is developing a range of product types that deliver prevention in innovative ways. This includes intravaginal rings, vaginal inserts, films and patches, vaginal gels combined with barrier methods, implants, oral tablets, long-acting injectables…the list goes on!
It remains unacceptable that women and girls worldwide continue to confront preventable sexually transmitted infections (STIs), including HIV, as well as face high rates of unintended pregnancies. It is unacceptable that advocates, scientists, and politicians still need to convince people that investing in, innovating around, and creating a supportive policy environment for women’s health is imperative. Public health figures should speak for themselves – women need access, innovation, more options for disease and pregnancy prevention. It has been nearly 40 years since the emergence of the HIV/AIDS epidemic, 60 years since the first birth control pill became available, and 90 years since penicillin was discovered and became a successful treatment for bacterial STIs. While many critical advances have been made in the decades following these sexual and reproductive health milestones, the continued suffering of millions of women worldwide means that we, as a public health community, need to do better.
Male Contraceptive Initiative, Thursday, 31 October 2019
Heather Boonstra | Leah Keller, Wednesday, 25 September 2019
IMPT Secretariat Staff | Kyli Gallington | Suzanne Ryan-Ibarra, Tuesday, 20 August 2019
Barbara Friedland, Monday, 22 July 2019
Laura Dellplain, Thursday, 20 June 2019