Guest blog contributors Martha Brady, PATH Director of Reproductive Health and Maggie Kilbourne-Brook, PATH Senior Program Officer, originally posted this commentary on the Initiative for Multipurpose Prevention Technologies (IMPT)’s blog.
We at PATH make it our business to reflect on the elusive topic of “what women want”—in terms of protection options in their sexual and reproductive lives. Not surprisingly, the answer is complex. Women want and need different things at different stages of their lifecycle, depending on the circumstances of their lives.
For decades, PATH has worked closely with women and girls in low-resource settings, as well as with diverse partner organizations, to develop, introduce, and scale up innovative technologies that improve women’s health. Our efforts include a strong focus on advancing women’s reproductive health literacy and decision-making autonomy not only as fundamental rights, but also as key building blocks to product uptake and effective use.
We have seen that in many countries women and girls face simultaneous risks for unintended pregnancy and sexually transmitted infections (STIs), including HIV. For these women, it could be ideal to use a single product that addresses all these health risks—and one that also fits the realities of their lives (things like living far from a health clinic with few resources or having limited ability to negotiate safer sex with their partners).
In this spirit, PATH and other product developers have been working for more than a decade to advance “multipurpose prevention technologies” (MPTs) to provide new options for women and girls to protect them from unintended pregnancy, HIV, and possibly other reproductive tract infections.
PATH takes an approach that goes straight to the source when identifying “what women want” from protection products. We engage women as co-designers—soliciting feedback on what they need, what they want, and which tradeoffs they can accept. They help us evaluate multiple versions so that we build acceptability into design throughout the process. We also work to understand the social, behavioral, and gender influences that shape women’s and girls’ ability to use products like MPTs so that we can address these in product design and introduction efforts.
The SILCS diaphragm was approved and is marketed in nearly 40 countries as the Caya® contoured diaphragm. Photo: PATH/Patrick McKern.
PATH’s user-centered approach has resulted in some innovative products that are getting into the hands of women. One example is the SILCS diaphragm—a one-size-fits-most diaphragm originally developed to expand women’s options for nonhormonal contraception, which could also meet women’s needs as an MPT when combined with a microbicide gel. This product meets many women’s needs by being nonhormonal, under their control, easy to use and comfortable, and not interfering with sex. The diaphragm achieved regulatory approvals as the Caya® contoured diaphragm and is marketed by Kessel medintim GmbH (Kessel) of Germany in nearly 40 countries. Preliminary studies have shown the feasibility and acceptability of SILCS and a microbicide gel as an MPT (see Beksinska M et al. [2018] and Frezieres RG et al. [2012]). The next step will depend on funding for clinical studies to assess safety and compatibility of using the Caya diaphragm as a delivery system for microbicide gel.
Another example of PATH’s innovative design development efforts is our work with microarray patch (MAP) technology. MAPs are a bandage-like drug delivery system, applied to the skin and worn for a short period of time. They have micro-projections that painlessly pierce the top layer of the skin and deliver a long-acting drug formulation.
With funding from the United States Agency for International Development, PATH and our partners are working to develop MAPs that could deliver a long-acting antiretroviral (ARV) drug for HIV protection, as well as a MAP to deliver an ARV and a hormonal contraceptive to protect from both HIV infection and unintended pregnancy. While MAP technology has been tested for a wide variety of drugs, including vaccines, this is the first time a MAP will be developed for HIV pre-exposure prophylaxis (PrEP) or as an MPT.
Working with partners in multiple countries, we will assess the technical feasibility of MAP formulations for HIV PrEP and multipurpose prevention, as well as ease of use and user acceptability of MAP prototypes to understand product characteristics that could influence ease of use, correct application, and acceptability. An MPT MAP could provide long-acting protection that could be easier to administer than an injection. PATH will work with women and health care providers in Kenya, South Africa, and Uganda to refine the MAP prototype and ensure it will meet users’ needs.
These are two examples of potential MPTs that could provide additional protection options for women and girls. We’re excited to continue collaborating with partners to make MPTs a reality for women and girls who want and need protection from both pregnancy and STIs. Ultimately, these MPT efforts build toward PATH’s larger goal: a world where women and girls everywhere have access to an array of options for their sexual and reproductive health needs. And a world where they have the knowledge and agency to use a product of their choice—all within the context of comprehensive programming embedded in well-functioning health systems.
This blog series is a collaboration with K4Health and also can be found on its topic page on contraceptive technology innovation.
The MAPs for PrEP project is made possible by the generous support of the American people through the United States Agency for International Development (USAID) through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), under the terms of Cooperative Agreement #AID-OAA-A-17-00015. The contents are the responsibility of PATH and do not necessarily reflect the views of USAID, PEPFAR, or the United States government.