Multipurpose methods: New prevention option?

When it comes to unplanned pregnancy and sexually transmitted diseases (STDs), young women, adolescents, and the poor often are the most at risk. However, women from all socioeconomic groups face challenges to their sexual and reproductive health.

Consider the global statistics. Each year:

  • more than 120 million couples have an unmet need for contraception;
  • an estimated 80 million women experience an unplanned pregnancy, of which 45 million end in abortion;
  • about 340 million people acquire new gonorrhea, syphilis, chlamydia, or trichomonas infections;1
  • nearly 2.7 million people are infected with HIV, and there are two million AIDS-related deaths.2

A new initiative has been formed to promote the development and use of multipurpose prevention technologies (MPTs), tools that prevent unintended pregnancy, STDs (including HIV), and/or other reproductive tract infections. Clinicians may recognize these as "combination" or "dual" technologies, No matter the nomenclature, these types of products represent an integrated reproductive health solution for women around the world.

The good news? Such MPTs as male condoms, female condoms, and diaphragms are now in existence, says Bethany Young Holt, PhD, MPH, director of the Northern California-based Coalition Advancing Multipurpose Innovations (CAMI), part of the Public Health Institute. CAMI serves as the non-aligned convener and facilitator for the new Initiative for Multipurpose Prevention Technologies (IMPT), a global health initiative that is aimed at raising awareness about and support for new and existing technologies that can be used in various combinations to address multiple reproductive and sexual health needs.

"One of the goals of this initiative is to think in new ways about prevention and health, and to help improve cross-communication, collaboration, and efficiencies between the various clinical areas: contraception, HIV/AIDS, STIs, sexuality, etc.," says Wayne Shields, president and chief executive officer of the Washington, DC-based Association of Reproductive Health Professionals, a member organization of the initiative. "The idea also is to combine currently available, soon-to-be available, and longer-term methods in unique ways that provide the best possible protection."

What's in exploration?

About 150 invited delegates from 11 countries gathered in March 2009 to discuss advancing prevention technologies. Attendees represented a wide range of disciplines: basic sciences, family planning, sociology, public health, and international development, says Holt. The initiative sprung from that effort. The United States Agency for International Development (USAID) provided seed money to track the pipeline of available and emerging MPTs as well as for an initial advocacy brief to help initiative members to articulate what is available and forthcoming in the field of multipurpose technologies. The San Francisco-based Mary Wohlford Foundation, a long time supporter of CAMI, also is providing core support.

What MPTs that are being explored? These approaches include combinations of devices and drugs, combinations of drugs or vaccines, and other novel approaches, such as:

• A one-size cervical barrier that delivers an HIV-preventing microbicide.

The device potentially could prevent pregnancy, HIV, and other pathogens. The SILCS Diaphragm, a single-size reusable device, was patented by Seattle-based PATH (Program for Appropriate Technology) in 1998. PATH has partnered with Arlington, VA-based CONRAD (Contraceptive Research and Development Program) to explore development of the device. Science also is eyeing the use of BufferGel, a novel microbicide developed by ReProtect of Baltimore, used with a emerging single-size barrier, called the Duet.

• A vaginal ring technology that simultaneously prevents HIV and herpes simplex virus.

This technology could be especially appealing to women at risk of either infection who want to have children. CONRAD is exploring such technology by combining tenofovir and acyclovir in a vaginal ring.3

• Combined vaccines that provide protection against human papillomavirus and hepatitis B virus.

Vaccines that protect against each of these infections are manufactured through similar processes, delivered on similar immunization schedules, and approved for co-administration, according to the initiative.4

• New delivery systems for microbicides, such as nanoparticles and bioresponsive gels.

Such systems eventually could be combined with antimicrobial agents to provide a dual defense against pathogens, according to the initiative.4

• Bacterial therapeutics.

Oral and vaginal administration of probiotics might be useful in preventing and treating bacterial vaginosis, urinary tract infections, HIV, and other infections.5

Look for more research to emerge on multipurpose technologies. USAID has earmarked funding to advance such investigations, says Holt.

Progress also is being made in products in the development pipeline. For example, the Woman's Condom, under development by PATH, is being evaluated in a Phase III contraceptive efficacy trial. The Woman's Condom is a 9-inch thin, pliable plastic pouch that conforms to the shape of the vagina. It has a flexible soft outer ring designed to protect the external genitalia, with four oblong foam pieces on the outside of the pouch which are engineered to cling lightly to vaginal walls, ensuring device stability. The distal end of the pouch and foam pieces are packaged into a capsule that serves as an insertion aid. It dissolves quickly when inserted into the vagina.6

References

  1. Holt BY, Kilbourne-Brook M, Stone A, et al. Multipurpose prevention technologies for sexual and reproductive health: gaining momentum and promise. Contraception 2010; 81:177-180.
  2. Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization. AIDS Epidemic Update 2009. Accessed at data.unaids.org/pub/Report/2009/2009_epidemic_update_en.pdf.
  3. Friend DR. Activity 1: Dual-Protection Technologies. Presentation. Accessed at www.conrad.org/assets/attachments/SAC_DualProtection_0127101.pdf.
  4. Coalition Advancing Multipurpose Innovations. Saving Lives With Multipurpose Prevention Technologies. Fact sheet. Accessed at www.cami-health.com/documents/MPT_FactSheet.pdf.
  5. PATH and the Coalition Advancing Multipurpose Innovations (CAMI). Saving Lives With Multipurpose Prevention Technologies: Turning Ideas Into Solutions for Sexual and Reproductive Health. Seattle: PATH; 2010. Accessed at www.cami-health.com/documents/MPT_SavingLivesBrief.pdf.
  6. Schwartz JL, Barnhart K, Creinin MD, et al. Comparative crossover study of the PATH Woman's Condom and the FC Female Condom. Contraception 2008; 78:465-473.