Post written by Hannah Rubens, Intern at CAMI Health and Madison Langrin, student at Johns Hopkins University and Intern at CAMI Health
Nearly half of women worldwide used modern methods of contraception in 2019. The World Health Organization reports that there are over 1 million new sexually transmitted infection (STI) cases globally each day. In the United States alone, as of this year, 1 in 5 people have an STI at any given moment, with national STI rates reaching yet another record high in 2019 -- for the sixth year in a row. Globally, people who use contraception and HIV/STI prevention methods face numerous barriers to accessing sexual and reproductive health (SRH) supplies and services. Stigma (both from loved ones and other community members including healthcare providers), cost, accessibility, geography, and education are recurring themes in the research on barriers to contraception and HIV prevention. Even the condom (internal and external) -- in many places the most mainstream and accessible contraceptive and HIV prevention method -- has inherent complexities in its use due to various inter-relational barriers. Despite opportunities for integration and the potential of Multipurpose Prevention Technologies (MPTs), the contraceptive, HIV, and STI prevention research and development (R&D) spheres remain siloed and underfunded.
The CTI Exchange’s Beginning with the End in Mind series highlights four key considerations for advancing the field of contraceptive R&D: acceptability, affordability, accessibility, and equity. The budding self-care movement, as it relates to SRH, offers significant potential for addressing these considerations. Colloquially, self-care has come to typify a handful of popularized behaviors and trends, but it also holds a much larger potential to empower autonomy over well-being at both an individual and systems level. The WHO conveys self-care as a movement towards an empowering environment where individuals have the resources, power, and knowledge to care for their health and well-being with the assistance of, rather than dependence upon, a health system. Within the realm of SRH, advances towards self-care include products that can be self-managed and de-medicalized, allowing the user to control when, how, and with what they use to protect themselves.
The last 18 months have highlighted the urgency for expanding self-administered options, as the pandemic has only exacerbated long-standing barriers to accessing contraception and health care. Now, more than ever, we must strive to advance a self-care choices that supports SRH options that amplify user autonomy. In their recent contribution to the Beginning with the End in Mind series, experts from the Population Council explored the importance of products that amplify self-care, envisioning a system that increases access, acceptability, affordability, and equity for family planning users globally.
CAMI Health seeks to join the conversation surrounding self-care by highlighting the unique contributions and benefits of the subset of multipurpose prevention technologies (MPTs) that could eventually become self-managed options. As the Secretariat of the Initiative for Multipurpose Prevention Technologies (IMPT), CAMI Health works to expand global research and education around MPTs, which are products that simultaneously prevent HIV, other STIs, and/or unintended pregnancies. We are dedicated to encouraging and assisting the development of a wide variety of MPTs to expand options available to end-users, including those that place individuals at the center of their decision-making.
MPTs have the power to revolutionize women's health by providing simultaneous prevention for multiple health risks. MPTs that combine HIV prevention and contraception may improve uptake of and adherence to HIV pre-exposure prophylaxis (PrEP) by offering streamlined product delivery and eliminating the need for multiple, separate clinic visits to address family planning and other SRH needs. Additionally, MPTs have the potential to expand self-care options in the SRH space, in alignment with the priority themes of accessibility and acceptability.
Currently, the pipeline of MPTs in development represents over two dozen product candidates spanning both short- and long-acting products, as well as a range of target indications and delivery platforms. With more comprehensive prevention options progressing through the R&D pathway, successful MPT products that reach the market could become a one-stop shop for SRH prevention. Likewise, socio-behavioral research is already being integrated in the MPT development process. The IMPT’s Socio-behavioral Research Hub keeps tabs on new research and findings in the field that center end-user preferences, so that, by the time these MPTs reach the market, they are well-aligned with what individuals will actually want and use.
In a not-so-futuristic world with diverse and streamlined options for protection, women will be empowered with ownership of their health, and the control to choose prevention products that align with their unique social and life circumstances. An innovative approach has the potential to challenge women’s and sexual and gender minorities’ historically-rooted reliance on external systems and people to meet their health needs. Offering all people an active role in their own healthcare is an exciting and important development on the path toward better care for everyone.
Developing sustainable and effective MPTs is not without its technical and social challenges. A concern surrounding self-administered products is the risk of user error, and this can apply to MPTs as well. To help mitigate this, educating healthcare providers and end-users about self-administration of MPTs will be very important.
Persistent stigma surrounding HIV poses an additional consideration for MPTs that combine HIV prevention and contraception. On one hand, users that are comfortable using contraception and are at risk for HIV may seamlessly accept an MPT that simultaneously prevents HIV. However, there is a chance that the presence of an HIV indication may deter others from using such combination products due to stigma or discrimination. Providing such MPTs through integrated SRH services or at a family planning clinic could help address this potential concern.
As the MPT R&D process continues, keeping issues of acceptability, accessibility, affordability, equity and technical feasibility as priorities is critical in fulfilling the promise of MPTs and a future where any person can have greater control over their own well-being. CAMI Health encourages MPT researchers and developers to acknowledge these priorities throughout the lifecycle of product development in an effort to ensure that the products being developed truly begin with the end-user in mind.
Have thoughts on this topic or the Beginning with the End in Mind series overall? Post your ideas on Twitter and LinkedIn, tag @ctiexchange, and use the hashtag #NextGenFP.
