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→‎Opportunities: separated previous opportunities section into advantages and opportunities for improvement + added how mpts can increase individual's adherence to preventative care
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The MPT field emerged from the [[Vaginal microbicide|microbicide]] field, a natural extension from the microbicide field’s focus on women-controlled methods to prevent HIV acquisition. <ref>Malcolm, R. K., Boyd, P., McCoy, C. F., & Murphy, D. J. (2014). Beyond HIV microbicides: multipurpose prevention technology products. BJOG: An International Journal of Obstetrics & Gynaecology, 121(s5), 62-69.</ref> In 1998, the Alliance for Microbicide Development was formed; however, it was disbanded after clinical trials for multiple microbicides did not show prevention of HIV transmission.<ref name=":2" /> In 2009, CAMI Health convened a multidisciplinary international meeting in Berkeley, California to formalize the MPT field which brought attention back to microbicides.<ref name=":2" /><ref>Young Holt, B., Romano, J., Manning, J., Hemmerling, A., Shields, W., Vyda, L., & Lusti‐Narasimhan, M. (2014). Ensuring successful development and introduction of multipurpose prevention technologies through an innovative partnership approach. BJOG: An International Journal of Obstetrics & Gynaecology, 121(s5), 3-8.</ref> The aim of the MPT was to prevent against any combination of HIV, other STIs, and unintended pregnancy. In 2011, the first major funding opportunity for MPT development was released by the [[National Institutes of Health]].<ref>{{cite web|url=https://grants.nih.gov/grants/guide/rfa-files/RFA-AI-11-016.html|title=RFA-AI-11-016: Combined Multipurpose Strategies for Sexual and Reproductive Health (R21/33)|website=grants.nih.gov}}</ref>
The MPT field emerged from the [[Vaginal microbicide|microbicide]] field, a natural extension from the microbicide field’s focus on women-controlled methods to prevent HIV acquisition. <ref>Malcolm, R. K., Boyd, P., McCoy, C. F., & Murphy, D. J. (2014). Beyond HIV microbicides: multipurpose prevention technology products. BJOG: An International Journal of Obstetrics & Gynaecology, 121(s5), 62-69.</ref> In 1998, the Alliance for Microbicide Development was formed; however, it was disbanded after clinical trials for multiple microbicides did not show prevention of HIV transmission.<ref name=":2" /> In 2009, CAMI Health convened a multidisciplinary international meeting in Berkeley, California to formalize the MPT field which brought attention back to microbicides.<ref name=":2" /><ref>Young Holt, B., Romano, J., Manning, J., Hemmerling, A., Shields, W., Vyda, L., & Lusti‐Narasimhan, M. (2014). Ensuring successful development and introduction of multipurpose prevention technologies through an innovative partnership approach. BJOG: An International Journal of Obstetrics & Gynaecology, 121(s5), 3-8.</ref> The aim of the MPT was to prevent against any combination of HIV, other STIs, and unintended pregnancy. In 2011, the first major funding opportunity for MPT development was released by the [[National Institutes of Health]].<ref>{{cite web|url=https://grants.nih.gov/grants/guide/rfa-files/RFA-AI-11-016.html|title=RFA-AI-11-016: Combined Multipurpose Strategies for Sexual and Reproductive Health (R21/33)|website=grants.nih.gov}}</ref>


== Opportunities ==
== Advantages ==
MPTs provide prevention for multiple indications. Because of this, MPTs have the opportunity to revolutionize sexual health.<ref name=":1" />
MPTs provide prevention for multiple indications. Because of this, MPTs have the opportunity to revolutionize sexual health.<ref name=":1" />


MPTs can help increase adherence to HIV pre-exposure prophylaxis (PrEP) by decreasing the number of clinic visits to address family planning and sexual health topics. Additionally, MPTs can reduce the stigma surrounding HIV and STI prevention by combining prevention for these indications into contraceptives, a less stigmatized product. <ref>{{Cite journal |last=Young Holt |first=Bethany |last2=Kiarie |first2=James |last3=Kopf |first3=Gregory S |last4=Nanda |first4=Kavita |last5=Hemmerling |first5=Anke |last6=Achilles |first6=Sharon L |date=2020 |title=Bridging the gap: advancing multipurpose prevention technologies from the lab into the hands of women† |url=https://academic.oup.com/biolreprod/article/103/2/286/5843376 |journal=Biology of Reproduction |language=en |volume=103 |issue=2 |pages=286–288 |doi=10.1093/biolre/ioaa085 |issn=0006-3363 |pmc=PMC7401373 |pmid=32657337}}</ref>
MPTs can help increase adherence to HIV pre-exposure prophylaxis (PrEP) by decreasing the number of clinic visits to address family planning and sexual health topics. Furthermore, because MPTs address multiple preventative care needs in one product, MPTs have the opportunity to increase adherence by decreasing the number of total administrations an individual may be responsible for.<ref>{{Cite journal |last=Bershteyn |first=Anna |last2=Resar |first2=Danielle |last3=Kim |first3=Hae-Young |last4=Platais |first4=Ingrida |last5=Mullick |first5=Saiqa |date=2023 |title=Optimizing the pipeline of multipurpose prevention technologies: opportunities across women's reproductive lifespans |url=https://www.frontiersin.org/articles/10.3389/frph.2023.1169110 |journal=Frontiers in Reproductive Health |volume=5 |doi=10.3389/frph.2023.1169110 |issn=2673-3153 |pmc=PMC10266103 |pmid=37325241}}</ref> Additionally, MPTs can reduce the stigma surrounding HIV and STI prevention by combining prevention for these indications into contraceptives, a less stigmatized product. <ref>{{Cite journal |last=Young Holt |first=Bethany |last2=Kiarie |first2=James |last3=Kopf |first3=Gregory S |last4=Nanda |first4=Kavita |last5=Hemmerling |first5=Anke |last6=Achilles |first6=Sharon L |date=2020 |title=Bridging the gap: advancing multipurpose prevention technologies from the lab into the hands of women† |url=https://academic.oup.com/biolreprod/article/103/2/286/5843376 |journal=Biology of Reproduction |language=en |volume=103 |issue=2 |pages=286–288 |doi=10.1093/biolre/ioaa085 |issn=0006-3363 |pmc=PMC7401373 |pmid=32657337}}</ref>


== Opportunities for Improvement ==
A survey was done in parts of sub-Saharan Africa which indicated that 96% of surveyed women prefer MPTs over single indication products. Despite this preference, there is limited funding for MPTs, which can make it difficult for individuals to gain access and afford these products. Going forward, there are opportunities to improve accessibility to help ensure individuals who can benefit from these products are able to obtain them in an accessible and affordable manner. <ref>{{Cite web |date=2021 |title=Multipurpose Prevention Technologies: Technology Landscape and Potential for Low- and Middle-Income Countries |url=https://www.phi.org/thought-leadership/multipurpose-prevention-technologies-mpts-technology-landscape-and-potential-for-low-and-middle-income-countries/ |access-date=2023-07-27 |website=Public Health Institute |language=en}}</ref>
A survey was done in parts of sub-Saharan Africa which indicated that 96% of surveyed women prefer MPTs over single indication products. Despite this preference, there is limited funding for MPTs, which can make it difficult for individuals to gain access and afford these products. Going forward, there are opportunities to improve accessibility to help ensure individuals who can benefit from these products are able to obtain them in an accessible and affordable manner. <ref>{{Cite web |date=2021 |title=Multipurpose Prevention Technologies: Technology Landscape and Potential for Low- and Middle-Income Countries |url=https://www.phi.org/thought-leadership/multipurpose-prevention-technologies-mpts-technology-landscape-and-potential-for-low-and-middle-income-countries/ |access-date=2023-07-27 |website=Public Health Institute |language=en}}</ref>


Revision as of 23:26, 27 July 2023

Multipurpose prevention technologies (MPTs) are a class of products designed to prevent two or more health issues simultaneously, often focusing on sexual and reproductive health (SRH) which includes contraception, the human immunodeficiency virus (HIV) prevention, other sexually transmitted infection (STI) preventions, such as genital infection by human simplex virus (HSV) infection and human papillomavirus (HPV) infection. [1] For example, MPTs combine contraception and HIV prevention, contraception and other STI prevention, or the prevention of multiple STIs. Since the simultaneous use of multiple products with single indication against specific sexual or reproductive health issues is inconvenient and may affect adherence, the development of MPT in one single product can combat this issue.

These products can be utilized by individuals who wish to conceive, as well as breastfeeding and pregnant individuals not using contraceptives.[2]

Types

A range of MPT products are in development since 2010.[3] The development pipeline includes different designs, product types, and configurations. While condoms are the only one available MPT product in the market, other MPT products in different forms are still in various phases of development. [4]


MPT products that are available:

  • Condoms - Male and female condoms are the only MPT products currently available. They are a non-hormonal form of MPT that combines contraception and HIV/STI preventions.[2]


MPT products in development:

  • Intravaginal ring (IVR) - IVRs are polyermic and flexible rings that are inserted into the vagina and delivers the drug to the surrounding vaginal tissue. IVRs are sustained formulations that takes from days to months for drug release. [5] There are already IVRs on the market that act solely as contraceptives, but IVRs that can act as MPTs are still in development.[6]
  • Gel (rectal or vaginal) - Gels are topical formulations used to deliver a drug to the desired tissue. Studies are being done to test vaginal gels with different microbicides for their effectiveness at preventing HIV and STI transmissions.[7]
  • Diaphragm with added microbicide - A diaphragm is a physical barrier that can be inserted into the vagina prior to sex that stops sperm from reaching the uterus. They are currently used in combination with gels and spermicides to add a chemical component to blocking sperm.[8] In its usage as a MPT, once effective candidates for vaginal gels are develop, they can be used together to provide contraception as well as HIV/STI prevention.[2]
  • Vaginal tablets (i.e., inserts) - Vaginal tablets and inserts can be used for both therapeutic and prophylaxis. They dissolve in the vaginal cavity after administration. Vaginal tablets and inserts contain hydrophilic polymers such as carbomers and sodium alginate to provide a mucoadhesive properties to allow time for drug release. Vaginal tablets and inserts are easy to use and handle, and providing precise dosing and good stability. However, a applicator is needed for administration which increases the cost. [5]
  • Vaginal films - Vaginal films are soft and thin sheets. They dissolve in the vaginal cavity after administration. Vaginal films contain many active ingredients and bioadhesive polymers to allow time for drug release. There are immediate and sustained formulation for vaginal films. Vaginal films are easy to use and handle.[5]
  • Vaginal patches
  • Oral pills
  • Injectables

Prevalence

HIV, other STIs, and unintended pregnancy continue to be a public health concern worldwide, all sharing a common link of exposure.[9] The importance of MPTs has been recognized for some time now, and condoms serve as an excellent example. However, the potential impact of preventing HIV infection through condoms has been diminished due to lack of usage among females and males.[10] As of 2022, approximately 39 million people worldwide are currently living with HIV[11]; around 374 million new cases of STIs arise each year[12], and nearly half (45%) of all pregnancies are unintended.[13]

History

The MPT field emerged from the microbicide field, a natural extension from the microbicide field’s focus on women-controlled methods to prevent HIV acquisition. [14] In 1998, the Alliance for Microbicide Development was formed; however, it was disbanded after clinical trials for multiple microbicides did not show prevention of HIV transmission.[10] In 2009, CAMI Health convened a multidisciplinary international meeting in Berkeley, California to formalize the MPT field which brought attention back to microbicides.[10][15] The aim of the MPT was to prevent against any combination of HIV, other STIs, and unintended pregnancy. In 2011, the first major funding opportunity for MPT development was released by the National Institutes of Health.[16]

Advantages

MPTs provide prevention for multiple indications. Because of this, MPTs have the opportunity to revolutionize sexual health.[2]

MPTs can help increase adherence to HIV pre-exposure prophylaxis (PrEP) by decreasing the number of clinic visits to address family planning and sexual health topics. Furthermore, because MPTs address multiple preventative care needs in one product, MPTs have the opportunity to increase adherence by decreasing the number of total administrations an individual may be responsible for.[17] Additionally, MPTs can reduce the stigma surrounding HIV and STI prevention by combining prevention for these indications into contraceptives, a less stigmatized product. [18]

Opportunities for Improvement

A survey was done in parts of sub-Saharan Africa which indicated that 96% of surveyed women prefer MPTs over single indication products. Despite this preference, there is limited funding for MPTs, which can make it difficult for individuals to gain access and afford these products. Going forward, there are opportunities to improve accessibility to help ensure individuals who can benefit from these products are able to obtain them in an accessible and affordable manner. [19]

References

  1. ^ Lusti‐Narasimhan, M., Merialdi, M., & Holt, B. (2014). Multipurpose prevention technologies: maximising positive synergies. BJOG: An International Journal of Obstetrics & Gynaecology, 121(3), 251-251.
  2. ^ a b c d Young Holt, Bethany; Turpin, Jim A.; Romano, Joseph (2021). "Multipurpose Prevention Technologies: Opportunities and Challenges to Ensure Advancement of the Most Promising MPTs". Frontiers in Reproductive Health. 3. doi:10.3389/frph.2021.704841. ISSN 2673-3153. PMC 9580637. PMID 36304018.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  3. ^ Friend, D. R. (2016). An update on multipurpose prevention technologies for the prevention of HIV transmission and pregnancy. Expert opinion on drug delivery, 13(4), 533-545.
  4. ^ Brady, M; Tolley, E (2014). "Aligning product development and user perspectives: social-behavioural dimensions of multipurpose prevention technologies". BJOG: An International Journal of Obstetrics & Gynaecology. 121: 70–78. doi:10.1111/1471-0528.12844.
  5. ^ a b c Fernandes, Trinette; Baxi, Krishna; Sawarkar, Sujata; Sarmento, Bruno; das Neves, José (2020-03-03). "Vaginal multipurpose prevention technologies: promising approaches for enhancing women's sexual and reproductive health". Expert Opinion on Drug Delivery. 17 (3): 379–393. doi:10.1080/17425247.2020.1728251. ISSN 1742-5247.
  6. ^ Thurman, Andrea; Clark, Meredith; Hurlburt, Jennifer; Doncel, Gustavo (2013). "Intravaginal rings as delivery systems for microbicides and multipurpose prevention technologies". International Journal of Women's Health: 695. doi:10.2147/IJWH.S34030. ISSN 1179-1411. PMC 3808127. PMID 24174884.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  7. ^ Obiero, Jael; Ogongo, Paul; Mwethera, Peter G; Wiysonge, Charles S (2021). Cochrane STI Group (ed.). "Topical microbicides for preventing sexually transmitted infections". Cochrane Database of Systematic Reviews. 2021 (3). doi:10.1002/14651858.CD007961.pub3. PMC 8092571. PMID 33719075.{{cite journal}}: CS1 maint: PMC format (link)
  8. ^ Harris, Danielle M.; Dam, Anita; Morrison, Kate; Mann, Chastain; Jackson, Ashley; Bledsoe, Shannon M.; Rowan, Andrea; Longfield, Kim (2022). "Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review". Studies in Family Planning. 53 (3): 455–490. doi:10.1111/sifp.12209. ISSN 0039-3665. PMC 9545114. PMID 35922382.{{cite journal}}: CS1 maint: PMC format (link)
  9. ^ Fernández-Romero, José A.; Deal, Carolyn; Herold, Betsy C.; Schiller, John; Patton, Dorothy; Zydowsky, Thomas; Romano, Joe; Petro, Christopher D.; Narasimhan, Manjulaa (2015). "Multipurpose prevention technologies: the future of HIV and STI protection". Trends in Microbiology. 23 (7): 429–436. doi:10.1016/j.tim.2015.02.006. PMC 4490993. PMID 25759332.
  10. ^ a b c Friend, David R.; Clark, Justin T.; Kiser, Patrick F.; Clark, Meredith R. (2013). "Multipurpose prevention technologies: Products in development". Antiviral Research. 100: S39–S47. doi:10.1016/j.antiviral.2013.09.030. ISSN 0166-3542.
  11. ^ "HIV and AIDS Epidemic Global Statistics". HIV.gov. Retrieved 2023-07-26.
  12. ^ "Sexually transmitted infections (STIs)". www.who.int. Retrieved 2023-07-26.
  13. ^ "Unintended Pregnancy | CDC". www.cdc.gov. 2023-06-15. Retrieved 2023-07-26.
  14. ^ Malcolm, R. K., Boyd, P., McCoy, C. F., & Murphy, D. J. (2014). Beyond HIV microbicides: multipurpose prevention technology products. BJOG: An International Journal of Obstetrics & Gynaecology, 121(s5), 62-69.
  15. ^ Young Holt, B., Romano, J., Manning, J., Hemmerling, A., Shields, W., Vyda, L., & Lusti‐Narasimhan, M. (2014). Ensuring successful development and introduction of multipurpose prevention technologies through an innovative partnership approach. BJOG: An International Journal of Obstetrics & Gynaecology, 121(s5), 3-8.
  16. ^ "RFA-AI-11-016: Combined Multipurpose Strategies for Sexual and Reproductive Health (R21/33)". grants.nih.gov.
  17. ^ Bershteyn, Anna; Resar, Danielle; Kim, Hae-Young; Platais, Ingrida; Mullick, Saiqa (2023). "Optimizing the pipeline of multipurpose prevention technologies: opportunities across women's reproductive lifespans". Frontiers in Reproductive Health. 5. doi:10.3389/frph.2023.1169110. ISSN 2673-3153. PMC 10266103. PMID 37325241.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  18. ^ Young Holt, Bethany; Kiarie, James; Kopf, Gregory S; Nanda, Kavita; Hemmerling, Anke; Achilles, Sharon L (2020). "Bridging the gap: advancing multipurpose prevention technologies from the lab into the hands of women†". Biology of Reproduction. 103 (2): 286–288. doi:10.1093/biolre/ioaa085. ISSN 0006-3363. PMC 7401373. PMID 32657337.{{cite journal}}: CS1 maint: PMC format (link)
  19. ^ "Multipurpose Prevention Technologies: Technology Landscape and Potential for Low- and Middle-Income Countries". Public Health Institute. 2021. Retrieved 2023-07-27.
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