Multipurpose prevention technologies for sexual and reproductive health: mapping global needs for introduction of new preventive products.

OBJECTIVES: Worldwide, women face sexual and reproductive health (SRH) risks including unintended pregnancy and sexually transmitted infections (STIs) including HIV. Multipurpose prevention technologies (MPTs) combine protection against two or more SRH risks into one product. Male and female condoms are the only currently available MPT products, but several other forms of MPTs are in development. We examined the global distribution of selected SRH issues to determine where various risks have the greatest geographical overlap. STUDY DESIGN: We examined four indicators relevant to MPTs in development: HIV prevalence, herpes simplex virus type 2 prevalence (HSV-2), human papillomavirus prevalence (HPV) and the proportion of women with unmet need for modern contraception. Using ArcGIS Desktop, we mapped these indicators individually and in combination on choropleth and graduated symbol maps. We conducted a principal components analysis to reduce data and enable visual mapping of all four indicators on one graphic to identify overlap. RESULTS: Our findings document the greatest overlapping risks in Sub-Saharan Africa, and we specify countries in greatest need by specific MPT indication. CONCLUSIONS: These results can inform strategic planning for MPT introduction, market segmentation and demand generation; data limitations also highlight the need for improved (non-HIV) STI surveillance globally. IMPLICATIONS: MPTs are products in development with the potential to empower women to prevent two or more SRH risks. Geographic analysis of overlapping SRH risks demonstrates particularly high need in Sub-Saharan Africa. This study can help to inform strategic planning for MPT introduction, market segmentation and demand generation.

Lessons from reproductive health to inform multipurpose prevention technologies: don't reinvent the wheel.

UNLABELLED: This paper presents the public health rationale for multipurpose prevention technologies (MPTs) for sexual and reproductive health (SRH) based on regional trends in demographic and SRH indicators. It then distils important lessons gleaned from the introduction of contraceptive and reproductive health products over the past several decades in order to inform the development and future introduction of MPTs for SRH. PRINCIPAL RESULTS: A comparison of current demographic and public health regional data clearly revealed that the greatest confluence of women's SRH concerns occurs in sub-Saharan Africa and South/West Asia. These regional overlaps of SRH risks and outcomes present a strong rationale for developing MPTs designed to simultaneously protect against unintended pregnancy, HIV and other STIs. Information from acceptability, marketing, and operations research on the female condom, emergency contraception, pills and intravaginal rings identified key product characteristics and socio-behavioral issues to be considered in the development and introduction of MPTs. Product characteristics such as formulation, duration of action, presence and magnitude of side effects, prescription status (over-the-counter vs. prescribed), provider type and training and user perspectives, all contributed in varying degrees to both provider and user bias, and subsequent uptake of these family planning methods. Underlying socio-behavioral issues, including risk perception, ambivalence, and social costs also contributed to demand and use. Early identification of target populations will be critical to market shaping, demand creation and defining appropriate service delivery channels for MPTs. Ultimately, knowledge, attitudes, perceptions and practices of users (and their partners) will drive the success- or failure- of product introduction. CONCLUSIONS: MPTs provide a compelling response to the multiple and reinforcing SRH risks faced by women in key regions of the world, but specific product characteristics and their socio-behavioral correlates must be taken into account early in the development process. Successful introduction of new MPTs will require solid understanding of socio-behavioral correlates, effective demand generation, appropriate integration into health service delivery systems, quality counseling for proper use and active engagement of both public and private sectors. This article is based on a presentation at the "Product Development Workshop 2013: HIV and Multipurpose Prevention Technologies," held in Arlington, Virginia on February 21-22, 2013. It forms part of a special supplement to Antiviral Research.

Prioritizing multipurpose prevention technology development and investments using a target product profile.

Multipurpose prevention technologies (MPTs) represent a powerful opportunity to address the unmet sexual and reproductive health needs of women in at-risk populations around the world in an efficient and cost-effective manner. The development of MPT products for the combination prevention of pregnancy and sexually transmitted infections (including HIV) is a high-risk/high-gain, expensive process. The associated challenges are compounded by limitations in available resources for the development, evaluation, and delivery of such products. Consequently, an objective process for identifying MPT products with the highest public health impact potential is necessary to serve as the basis of coordinated investment of supporting agencies in the development of such products. Moreover, this process would serve as a framework for product development organizations, guiding their product development strategies. The Scientific Agenda Working Group of the Initiative for Multipurpose Prevention Technologies conducted an MPT pipeline evaluation exercise for the purpose of defining specific MPT product priorities, and to identify MPT technology gaps which need to be addressed in order to achieve development of optimal products. Through a formal and objective process, a set of MPT priority product recommendations emerged, along with several priority MPT gaps. Further, specific MPT development process priorities were identified. The detailed process and summary findings of this exercise are presented here. This article is based on a presentation at the "Product Development Workshop 2013: HIV and Multipurpose Prevention Technologies," held in Arlington, Virginia on February 21-22, 2013. It forms part of a special supplement to Antiviral Research.

The chemical composition and bacteria communities in acid and metalliferous drainage from the wet-dry tropics are dependent on season.

Acid and metalliferous drainage (AMD) occurs when sulphidic minerals, such as arsenopyrite, chalcopyrite and pyrite, are exposed to oxygen and water. Climate, geology and mine site practices can have a significant impact on AMD composition. The elemental composition of the AMD can also affect the bacterial community. Our hypothesis was that in the dry season the AMD at two mine sites, Rum Jungle and Mt Todd, in the Northern Territory, Australia, has a higher concentration of dissolved metals because standing water evaporates during the extended dry period. Our second hypothesis was that the wet and dry season bacteria community in AMD at Rum Jungle and Mt Todd are different, and this difference is correlated to seasonally specific changes in physicochemistry. The first hypothesis was tested by measuring elemental concentrations in AMD during the wet and dry seasons at Mt Todd and Rum Jungle mine sites. The physicochemical properties such as temperature, pH and dissolved oxygen were also measured. To test the second hypothesis, we extracted DNA from AMD samples collected at Rum Jungle and Mt Todd during the wet and dry seasons. The hypervariable V6 region of the bacterial 16S rRNA gene was sequenced by 454 pyrosequencing. The bacterial community composition was examined and related to physiochemical variables. The elemental concentrations in Rum Jungle AMD were higher in the dry season compared to the wet season, but at Mt Todd the elemental composition of AMD changed with year, rather than season. The bacteria community in AMD at Rum Jungle changed between the wet and dry season while in Mt Todd AMD the bacteria community from year 1 was significantly different from year 2. The data showed that the elemental composition and bacteria communities of AMD at Rum Jungle and Mt Todd are influenced by season, mine site practices and geological characteristics of the ore body. In addition, the iron oxidising bacteria Leptospirillum and Acidithiobacillus typically associated with AMD in temperate regions were not prevalent at out tropical study sites.

Standardized definitions of failure modes for female condoms.

Definitions of male condom failure modes are now well documented, and failure events are usually reported as the proportion of the total number of condoms used and the proportion of men/couples who experience an event. The lack of standardized definitions for female condom (FC) failure has led to variability in reporting and hence difficulties in making comparisons across studies. As a result, the World Health Organization convened a technical review committee meeting in January 2006 through which the members compiled and agreed to a standard list of terms and definitions for each of the failure modes. These failure modes apply to FCs currently marketed or in advanced stages of clinical testing. They were designed to assist in the review and comparative assessment of different FCs.