Researchers and advocates underscore the need for MPTs at Women Deliver 2013

Over the course of her life, a woman will have varying sexual and reproductive health needs. Yet, “what stays constant is her need for prevention against HIV, unintended pregnancy and STIs,” explained Dr. Nomita Chandihok, Deputy Director of Reproductive Health and Nutrition at the Indian Council of Medical Research during a session at the Women Deliver 2013 conference in Kuala Lumpur. Addressing women’s multiple health needs in a single product was the focus of the session, “Multi-purpose Prevention Technologies for Girls and Women.” It convened a diverse group of experts from the non-profit, advocacy, government and research sectors, who spoke to the need for multipurpose prevention technologies (MPTs), the current pipeline of products, funding and investment for R&D and the implications for women living with HIV.

Dr. Anke Hemmerling, Director of UCSF Bixby Center for Global Reproductive Health, and Ms. Manju Chatani, Senior Program Manager at AVAC, moderated, opening with the question, “Why multi-purpose prevention technologies?” The growing focus on MPTs in recent years – indicated by the creation of groups such as the Coalition Advancing Multipurpose Innovations (CAMI) and the Initiative for Multipurpose Prevention Technologies (IMPT) – stems from the desire to achieve greater efficiency in terms of cost, access and delivery of sexual and reproductive health (SRH) prevention products that can improve women’s lives by comprehensively responding to their health needs.

What Are MPTs and Why Do We Need Them? What’s Available Now and On the Horizon?

Dr. Nomita Chandihok, Deputy Director of Reproductive Health and Nutrition, Indian Council of Medical Research

Underscoring the importance of new technologies that target at least two SRH indicators simultaneously, Dr. Chandihok shared recent data on unintended pregnancy rates and the prevalence of STIs, including HIV. Each year, 16 million adolescent girls give birth, 1.8 million women die of AIDS, and other STIs have their own health implications and compound pregnancy- and HIV-related health outcomes. There are already MPTs on the market, namely male and female condoms, aimed at addressing the multiple health burdens, as well as a number of products in development to complement the existing toolkit. MPTs on the horizon include on-demand products, such as barrier devices and active agents, and sustained release devices. Speaking to the benefits of MPTs, Dr. Chandihok said, “There are different needs in different countries and different needs for married and unmarried women. MPTs can provide different combinations based on preferences and needs.”

Microbicides: Where Are We Today?

Dr. Zeda Rosenberg, CEO, IPM

Dr. Zeda Rosenberg, CEO of IPM, offered an in-depth look at several of the MPTs currently in development. IPM is a nonprofit product developer of SRH technologies for women that is leveraging its expertise in the microbicide development to create products that can address several health indicators. Microbicides now in late-stage clinical trials are “one step to MPTs,” explained Dr. Rosenberg. “Data from the microbicide field can be used to develop and expand the MPT pipeline.” Building on the technology of IPM’s antiretroviral (ARV)-based vaginal ring for HIV prevention, IPM is in the preclinical stages of a dual-purpose vaginal ring that contains the ARV dapivirine and contraceptive levonorgestrel to provide simultaneous protection against HIV infection and unintended pregnancy. The thing with MPTs is that “you can have thousands of possible options of combinations [for STI, pregnancy and HIV prevention], so there needs to be prioritization,” said Dr. Zeda Rosenberg. To make these determinations, we need to listen to the target population. This means knowing, “what women want, what they need and how we develop this.”

Aligning Investments in R&D

Dr. Judy Manning, Health Development Officer, USAID

Expanding on the issue of MPT prioritization, Dr. Judy Manning, Health Development Officer at USAID, discussed recent research conducted by the IMPT to determine how to advance the MPT pipeline in light of so many options. “We need to have some consensus on which of these products looks the best as a group – as a field – to move some of these forward,” she said. The study of interest surveyed researchers and service providers in the U.S., Africa and Asia to understand what they see as priorities in the context of MPT development. While there were some regional differences due to local disease burdens, the study revealed that – of all the MPT options possible – there is widespread interest in on-demand formulations, vaginal rings and long-acting injectables. ARVs and hormonal contraceptives are the most desired active pharmaceutical ingredients. This research will help inform future MPT R&D.

What Do These Technologies Mean for Women Living with HIV?

Ms. Georgina Caswell, Program Officer, Global Network of People Living with HIV

As the final speaker of the session, Ms. Georgina Caswell, Program Officer at the Global Network of People Living with HIV, brought the critical perspective of women already infected with HIV to the conversation on MPTs. “Women living with HIV have been among the most powerful advocates for MPTs,” she said. Some of the benefits of MPTs for HIV positive women include greater acceptability and adherence because of the “multi” nature of the products, reduced stigma and discrimination associated with care and treatment and sustained engagement in health services and referral systems. Despite all of these advantages, women infected with HIV continue to face challenges related to MPT use, including barriers to access and on-the-ground realities, such a gender-based violence, discrimination and poverty. Ms. Caswell explained that these difficulties only underscore the critical importance of continuing to advance MPT development for both HIV-positive and -negative women. As an HIV-positive mother told her, “The more choices I have, the more likely I am to find the one that works for me – and therefore use.”