Program seeks Council approval for an initiative titled “Advancing the Science of Multipurpose Technology for the Prevention of HIV and Unintended Pregnancy.” Despite recent advances in the field of multipurpose prevention technology, gaps in understanding still remain. This initiative will serve to stimulate the field to address key gaps and propel the field forward.
There are over 86 million unintended pregnancies and over 2 million new cases of HIV yearly throughout the world. Adolescent and young women account for 60% of new infections in sub-Saharan Africa (SSA) and other regions. The development of multipurpose prevention technologies for HIV prevention and contraception or sexually transmitted infections is a critical next step. The development of multipurpose prevention technology would provide an option for combined protection and enhance adherence for the woman and her partner. Currently methods, oral PrEP and Dapivirine ring, provide single protection against HIV and have been shown to be effective for individuals who are adherent. However, they have not been as successful in the younger age group and are theorized to be due to either lack of adherence or biological mechanisms in the vaginal tract of adolescents. The Dapivirine ring was found to be effective in women over the age of 25 but deemed not protective against HIV in women under the age of 21. The advantage of a longer duration delivery system for HIV prevention (e.g., the Dapivirine ring) and long acting contraceptive (e.g., levonorgesterol) or non-hormonal contraceptives such as copper IUD is to allow the products to fit into a woman’s schedule seamlessly to improve adherence.
However, the appropriate dosing of anti-retroviral and contraceptive is important to confer the protection intended. Endogenous hormonal factors, drug-drug interactions, vaginal microbiota, and immune factors could interfere with achieving the dosing needed to deliver that protection. Similarly, the behavior of adolescents and young adults and the factors that may influence choice and adherence to products needs to be taken into account. More information is needed to address these questions if effective MPTs are to be developed for adolescent girls and young adults. Currently, there is only one dual protection product in phase I clinical trial. Viable alternatives need to be developed.
The goals of this initiative will be to advance the knowledge that would result in innovative delivery systems or approaches, new hormonal contraceptive and ARV combination options, or non-hormonal multipurpose combinations. Each proposal should focus on adolescent girls and young adults. Such knowledge could improve prevention and treatment measures to control the HIV epidemic in adolescents and young adults, while also addressing the high unplanned pregnancy rates.
The purpose of this initiative is aligned with branch’s high priority areas of reducing HIV/AIDS infections and health disparities among young adults and aligned with NICHD’s vision of Developmental Origins of Health and Disease.
This initiative addresses the overarching HIV/AIDS priorities of a) reducing the incidence of HIV/AIDS infections and b) basic research: understanding the basic biology of HIV transmission and pathogenesis.
Maternal and Pediatric Infectious Disease Branch
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