This week’s guest contributors to our blog series on product acceptability are Vanetta Thomas, Research Associate, and Laura Dellplain, Project Manager, who work on the Initiative for Multipurpose Prevention Technologies.*
What if women could prevent pregnancy and protect themselves against sexually transmitted infections (STIs) like HIV using a single product? Can a suite of such products be created to meet the varied needs, preferences, and life circumstances of women around the world?
Researchers in the field of multipurpose prevention technologies (MPTs) are working to answer these questions. Since women’s needs aren’t one-size-fits-all, MPTs are being developed to provide varied combinations of contraception, HIV prevention, and other STI prevention. Some are in the form of a daily oral tablet while others are topical (intravaginal ring (IVR), vaginal insert, vaginal film), or in a longer-acting design (injectable, intrauterine system, or subcutaneous implant). Some products prevent pregnancy and HIV, some prevent pregnancy and other STIs, and others prevent HIV and other STIs but allow for conception.
With many MPTs still in early stages of development, plenty of opportunities exist to incorporate women’s needs and desires into final product designs. We already know from social-behavioral research that women theoretically like the idea of using a product that addresses more than one sexual health concern. In a Phase I trial of a vaginal microbicide, Morrow et al. found that most women indicated it would be “extremely important” for a product to protect them from both HIV and other STIs. Woodsong et al. found that most women participating in the Duet Microbicide Trials in Malawi and Zimbabwe, as well as their partners, healthcare professionals and community stakeholders, favorably viewed an MPT that provided contraception as well as protection against HIV. Recent discrete choice experiments by Vickerman et al. suggest that a multipurpose product may have higher uptake among young South African women than a single-indication HIV prevention product.
While this continued validation is encouraging, we still have much to learn about possible MPT product attributes that best fit women’s lifestyles. What we know so far about what women want in an MPT mostly comes from HIV prevention clinical trials. One important lesson from these trials is that while products may be effective among consistent users, adherence remains a challenge, particularly for younger women. The good news is that we’ve learned from these trials’ successes and failures and can adapt future research designs accordingly through demonstration projects; increased awareness, education, and sensitization of a novel product; and partner buy-in facilitation.
Researchers have begun to pinpoint MPT features that women find most desirable and to assess comparative acceptability of a range of MPT options. The market research firm, Ipsos, recently surveyed women at risk of HIV in Uganda, Nigeria and South Africa about acceptability of and interest in four hypothetical MPT product designs. An overwhelming majority of women wanted a dual protection method, most preferring implants and injectables. Intravaginal rings and films were favored by some women, with preferences varying by geographic setting. Two other studies, TRIOand QUATRO, are currently assessing acceptability, preference, and the user experience of various MPT delivery forms, including vaginal delivery forms (gels, rings, inserts, and films), injectables and daily oral pills. While the TRIO research found that injections are the most preferred form, women’s acceptability of all three prototypes (tablets, IVR and injections) increased after use. These findings reiterate the need for the availability of a suite of products; they also support the concept of “user experience studies” to collect information on women’s experiences in using an actual prototype of a potential MPT and then making design changes early in the development phase.
When we think about MPTs, understanding the “fit” between the product and a woman’s life context may be quite complex. After all, a woman’s product experience is not only influenced by the physical device, but also by the meaning she infers from the types of protection it offers. How does an otherwise healthy woman prioritize STI prevention? Are HIV prevention and pregnancy prevention valued differently by women? By their partners? Could the contraceptive component of an MPT help make the HIV prevention component more attractive, especially among women who feel unwanted pregnancy is a more serious concern? Could the stigma that surrounds HIV deter some women from using a contraceptive MPT?
Work by Tolley and Guthrie can be instructive on how to think about acceptability and how to prioritize the user experience in product design. To ensure that MPTs are not only tolerable but also desirable, women’s voices must be engaged early and integrated meaningfully into an iterative product design process. Their voices should also inform the packaging design, marketing, and roll-out strategy.
MPTs are intended to improve and simplify the lives of women by providing innovative options that address multiple potential risks simultaneously. Their success will depend on what women worldwide think about the products and what they prioritize. For these reasons, women’s opinions must be at the center of MPT development – not an afterthought.
*The Initiative for Multipurpose Prevention Technologies is a product-neutral international collaboration committed to advancing the development of MPTs to address the interlinked risks of unintended pregnancy and sexually transmitted infections (STIs), including HIV. Housed at the Public Health Institute and funded by the U.S. Agency for International Development the National Institutes of Health, the Initiative works to synthesize the growing knowledge in this space, identify research gaps and priorities, facilitate dialogues and partnerships to identify new MPT approaches, generate financial support for research and development, and advocate for a continued focus on MPT solutions.