As strategies to prevent HIV and unintended pregnancies evolve, concepts of “multi-purpose technologies” raise a familiar question . . .

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What do women want?

While two trials test vaginal rings to fight HIV, market research highlights respondents’ interests in different options

SummaryBookletIt’s a question that gained gravity last year when an ambitious trial to identify ways women could use to protect themselves from HIV infection yielded disappointing but unsurprising findings. Nothing, results of blood tests and subsequent interviews showed, would be effective if women didn’t use it, and women wouldn’t use products that didn’t fit among the needs, constraints and challenges of their lives. For many of the 5000 women across three African countries enrolled in the VOICE trial — to find Vaginal and Oral Interventions to Control the Epidemic — that included using an antiretroviral-loaded vaginal gel or taking an antiretroviral pill on a daily basis.

So with opportunities now to merge new and existing technologies that together could provide women with options to protect themselves from HIV infection (and potentially other sexually transmitted infections) while preventing unintended pregnancies, researchers noted the need to include the input of the eventual consumers of the products early, openly, and comprehensively. A given in the world of cosmetic and toiletry development, it’s called market research. On Wednesday, market research on the demand and preferences around combined approaches to HIV and family planning among women in Uganda, Nigeria and South Africa, was the topic of a webinar presented by CAMI — a coalition of researchers, biotech developers, advocates and providers advancing multi-purpose sexual and reproductive health products, and AVAC.

Carried out by Ipsos Healthcare and funded by the Bill & Melinda Gates Foundation, the aim of the research was both broad and specific:

“A major object was to understand women and the lives they lead,” Moushira El-Sahn of Ipsos said. In particular, researchers sought to discover the potentials of four possible products to fit into women’s lives and meet their needs. All would be designed to prevent both HIV infection and unintended pregnancies, one through injections, one through a drug-dispersing implant, one through a film inserted into, and dissolving in the vagina, and one through a silicone ring inserted into and worn in the vagina.

Women’s lifestyles, goals and needs varied notably by country, researchers found, with, for example, women interviewed in South Africa saying they had more sexual partners, and more sex, than women in Uganda and Nigeria, and wanting fewer children. At the same time, interviews and data in the latter two countries indicated that needs for contraception were not being met. Who pays for contraception varies as well — in South Africa expenses are covered by public health services, in Uganda, most women pay for the contraception they use, and in Nigeria, where condoms were commonly cited, men do. While just 9 percent of women interviewed in South Africa said they counted on being faithful to one partner to avoid HIV infection, 47 percent of women interviewed in Uganda said they relied on that method.

But when researchers asked women if they would be interested in a combined product to protect against both HIV and unintended pregnancy, responses were more unified, with 93 percent of women interviewed overall saying they would be interested — 95 percent in South Africa, 92 percent in Uganda, and 94 percent in Nigeria.

If all four methods considered in the project were available today, the most popular would be implants — overall 41 percent would choose implants (46 percent in South Africa, 35 percent in Uganda, 44 percent in Nigeria.). The least popular would be rings, with an overall  9 percent of respondents  saying they would choose rings (10 percent in South Africa, 7 percent in Uganda, and 9 percent in Nigeria).

These answers come at a time when two trials of antiretroviral containing vaginal rings to prevent HIV acquisition represent the current most ambitious efforts to develop a microbicidal female controlled HIV-prevention method. The Ring and ASPIRE trials, running concurrently as “sister studies” — to speed approval if they show effectiveness —  across more than 20 sites in Africa, involve more than 4500 women. Testing a device that could remain in place and effective for a month at a time could, researchers have said, address the challenges discovered during the VOICE trial in use of a daily product. But the ring studies began before the VOICE trial had begun to yield its information, and raised its broader questions on what else researchers need to learn about what women don’t want.

While the Ring and ASPIRE trials have yet to yield their answers, researcher El-Sahn summed up one conclusion from the answers she found.

“When we are developing MPTs, we have to put women at the center,” she said. “What it means is we need to think about what we’re developing and funding.”

For more on the project, see the Summary Booklet, Assessing the Potential of MPTs in South Africa, Uganda, and Nigeria.

For more on the development of multi-purpose technologies, visit the website for CAMI, which serves as the secretariat for the Initiative for MPTs, and the World Health Organization website where a video on MPTs is posted.

One thought on “As strategies to prevent HIV and unintended pregnancies evolve, concepts of “multi-purpose technologies” raise a familiar question . . .

  1. Moushira El-Sahn

    Thank you Antigone for the article on this work!

    A link to this work can be found from the CAMI Health and AVAC websites:
    CAMI Health, forwards the importance of putting women and girls at the heart of MPT product development as shown by this poignant video:

    We would also like to take the opportunity to discuss a matter slightly more.
    This work was an important part of the story, in particular for products in development.
    We also have to appreciate the realities which surround this work and the HIV prevention discourse. In 2015 we will get data on whether two major HIV prevention tools (as your article discusses) the TFV gel (FACTS trial) and DPV ring (ASPIRE trial) are clinically successful. If they are proven clinically a viable way to protect women from acquiring the HIV virus, and with all the funding behind it, then research is needed to understand how to optimize their impact. This work should also place women at the center, but the healthcare system they will engage with and market dynamics at large.

    This is what the landscape currently looks like for the tools to prevent HIV (alongside oral PrEP although roll out needs more concentration and male condoms), therefore these tools will need attention in order to truly maximize impact, whilst others may be in development.

    So the ring maybe not the ideal MPT (no one MPT showed was in fact ideal), however if the reality is that it is one of the most viable options for preventing HIV acquisition, and potentially used to combine other prevention (alongside the TFV gel and oral PReP) then we should understand how to ensure the most optimal uptake.

    Thank you!
    All the best,
    Moushira & Jeff


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