Multipurpose Prevention Technologies: A Game-Changer for STI Prevention

Background:  Women at risk for sexually transmitted infections (STIs), including HSV-2, HIV, and others are often simultaneously at risk for unplanned pregnancy. Multipurpose prevention technologies (MPTs) that simultaneously prevent STIs and unplanned pregnancies provide women and girls with comprehensive prevention in a single product, efficiently addressing these critical unmet medical needs. The CAPRISA 004 and VOICE trials suggested that 1.0% tenofovir (TFV) could be effective at preventing sexual transmission of HSV and HIV to women.  However, low product adherence likely prevented adequate demonstration of such protection.  Poor acceptability, lack of perceived risk, or indication related stigma may have resulted in low levels of adherence.

Methods:  The Initiative for Multipurpose Prevention Technologies (IMPT) is an international coalition working to advance MPT product development and access through a broad scope strategy. As part of this effort, we hypothesized that increasing the STI prevention prospects for antiretroviral agents—particularly available TFV products--may be possible by incorporating this drug into an alternative product that is also contraceptive, thereby addressing possible drivers behind low adherence.

Results: Multiple TFV-contraceptive products are now in development and designed to test the above hypothesis.  A TFV-Levonogestrel vaginal ring designed to prevent HSV, STI and pregnancy is approaching clinical evaluation by CONRAD.  Other innovative MPT vaginal ring strategies with TFV and hormonal contraceptives (HC) are also in earlier stage product development, as are non-ring based MPT products with TFV and HC or barrier methods.  Effective development and delivery strategies for such products are crucial to achieving desired public health impact.

Conclusions: MPTs are a potential game-changer for STI prevention. Specific products designed to capitalize on target population willingness to use contraceptives that also prevent STIs are in development and provide a meaningful opportunity to address adherence issues and address important unmet need among at risk women.