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Mukherjee J, Rawat S, Ul Hadi S, Aggarwal P, Chakrapani V, Rath P, Manchi P, Aylur S, Malhotra S, Keane M, Gangaramany A. Understanding the Acceptability of Broadly Neutralizing Antibodies for HIV Prevention Among At-Risk Populations and Feasibility Considerations for Product Introduction in India: Protocol for a Qualitative Study. JMIR Res Protoc 2024; 13:e47700. [PMID: 38324364 PMCID: PMC10882480 DOI: 10.2196/47700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/03/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Acceptability and preference research play a crucial role in the design, evaluation, and implementation of any new prevention product in any geographical setting. They also play a critical role in the development of clinical guidelines and policies. A wide range of acceptability studies have been conducted in diverse general and key populations for various new HIV prevention products worldwide. As clinical development strategies are being developed for clinical studies of broadly neutralizing antibodies (bNAbs) as potential HIV prevention products, appropriately tailoring them to address the type of HIV epidemic at hand would be critical for efficient uptake within in-country public health systems and decrease adoption and adherence challenges. Accomplishing this will require comprehensive acceptability and feasibility studies to inform multisectoral efforts that increase access to these products and national policies supportive of access to health care for those in most need. Thus, it is both opportune and important to undertake focused efforts toward informing product development strategies. OBJECTIVE This study aims to understand preferences for product attributes and key behavioral factors influencing adoption and uptake of bNAb prevention products among end-users including female sex workers, men who have sex with men, transgender women, people who inject drugs, and adolescent girls and young women in India and understand the key health system and programmatic perspectives toward the introduction of bNAb prevention products from health service providers and policy makers in India. METHODS A multisite study will be conducted in Delhi, Mumbai, and Chennai to capture the differences in perspectives among diverse end-users and key informants across the country. The study will use a multimethods design using focus group discussions, in-depth interviews, simulated behavioral experiments, and key informant interviews. A total of 30 focus group discussions, 45 in-depth interviews, 15 simulated behavioral experiments sessions, and 15 key informant interviews will be conducted across 3 sites. RESULTS The data collected and analyzed will enable insights on which specific product attributes matter the most to the populations and why some attributes are less preferred; contextual drivers of preferences and choices at individual, interpersonal, social, and structural levels; and relative positioning of bNAb products among other potential HIV prevention products. Insights from the health service providers and policy makers will provide a critical understanding of the need perception of the potential product in the existing product landscape and what additional efforts and resources are required for potential introduction, delivery, and uptake of the bNAb products in the Indian context. CONCLUSIONS Insights generated from the abovementioned objectives will represent perspectives of populations of interest across geographies in India, will provide an overview of the acceptability of bNAb products and the feasibility of their introduction in this region, and will inform product development strategies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47700.
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Affiliation(s)
| | | | - Saif Ul Hadi
- International AIDS Vaccine Initiative, Gurugram, India
| | | | | | | | | | - Srikrishnan Aylur
- Yeshwant Rao Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Shelly Malhotra
- International AIDS Vaccine Initiative, New York, NY, United States
| | - Margaret Keane
- International AIDS Vaccine Initiative, New York, NY, United States
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Chakrapani V, Loganathan V, Saha P, Bose DL, Khan N, Aurora T, Narayan J, Mukherjee J, Hadi SU, Dewan C. Engagement of vulnerable communities in HIV prevention research in India: a qualitative investigation. Res Involv Engagem 2024; 10:12. [PMID: 38273406 PMCID: PMC10811827 DOI: 10.1186/s40900-024-00542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Meaningful community engagement (CE) in HIV prevention research is crucial for successful and ethically robust study implementation. We conducted a qualitative study to understand the current CE practices in HIV prevention research and to identify expressed and implicit reasons behind translational gaps highlighted by communities and researchers. METHODS For this exploratory qualitative study, we recruited a purposive sample of participants from Indian government-recognised key populations such as men who have sex with men, transgender women, people who inject drugs and female sex workers; general population adults and adolescents/youth; and researchers. We conducted 13 virtual focus groups (n = 86) between July and October 2021. Data were explored from a critical realist perspective and framing analysis (i.e., examining how the participants framed the narratives). RESULTS Participants reported that study communities, especially those from key populations, were primarily involved in data collection, but not necessarily with optimal training. Involvement of communities before the start of the study (e.g., obtaining feedback on the study's purpose/design) or once the study is completed (e.g., sharing of findings) were highlighted as priorities for meaningful engagement. Participants suggested meaningful CE in all stages of the study: (1) before the study-to get inputs in finalising the study design, drafting comprehensible informed consent forms and culturally-appropriate data collection tools, and deciding on appropriate monetary compensation; (2) during the study-adequate training of community field research staff; and (3) after the study-sharing the draft findings to get community inputs, and involving communities in advocacy activities towards converting evidence into action, policy or programs. Timely and transparent communications with communities were explicitly stated as critical for gaining and maintaining trust. Mutual respect, reciprocity (e.g., appropriate monetary compensation) and robust community feedback mechanisms were considered critical for meaningful CE. CONCLUSIONS The findings highlighted the translational gaps and priority areas for capacity building to strengthen CE in HIV prevention research. It is not only important to engage communities at various stages of research but to understand that trust, dignity, respect, and reciprocity are fundamentally preferred ways of meaningful community engagement.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), 119/2, Mathura Flats, Anna Nagar West Extension, Chennai, 600101, India.
| | - Vijayalakshmi Loganathan
- Centre for Sexuality and Health Research and Policy (C-SHaRP), 119/2, Mathura Flats, Anna Nagar West Extension, Chennai, 600101, India
| | - Paromita Saha
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Devi Leena Bose
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Nabeela Khan
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Tiara Aurora
- Quicksand Design Studio, 7A, Sanskriti Kendra, Anandagram, MG Road, Aya Nagar, New Delhi, 110047, India
| | - Jyoti Narayan
- Quicksand Design Studio, 7A, Sanskriti Kendra, Anandagram, MG Road, Aya Nagar, New Delhi, 110047, India
| | - Joyeeta Mukherjee
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Saif Ul Hadi
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Chitrangna Dewan
- Quicksand Design Studio, 7A, Sanskriti Kendra, Anandagram, MG Road, Aya Nagar, New Delhi, 110047, India
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Bauermeister JA, Tingler RC, Ho K, Scheckter R, McClure T, Davis J, Piper J, Friedland BA, Edick S, Song M, Jiao Y, Hendrix CW, Hoesley C. Acceptability of PC-1005 Gel Administered Rectally to HIV-1 Seronegative Adults at Three Different Volume Levels (MTN-037). AIDS Educ Prev 2022; 34:257-271. [PMID: 35994578 PMCID: PMC9924357 DOI: 10.1521/aeap.2022.34.4.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Multipurpose prevention technologies (MPT) have been increasingly researched for their dual-purpose preventative properties against HIV and other STIs. The acceptability of PC-1005, a topical MPT candidate, was explored among men and women participating in the MTN-037 Phase I trial at two U.S. sites (Pittsburgh, PA, and Birmingham, AL). We triangulated quantitative and qualitative assessments of the acceptability of three volumes (4 mL, 16 mL, 32 mL) of PC-1005 administered rectally (N = 12; 6 males, 6 females). Participants rated overall gel acceptability on a scale of 1-10, with a median of 7.17 (SD = 2.04) and had positive feelings about all three dose volumes, citing them to be very comfortable or comfortable (dose 1 = 91.7%; dose 2 = 91.7%; dose 3 = 83.3%). High acceptability of and comfort with all three dose volumes shows promise for PC-1005 as an MPT to prevent HIV and STIs, warranting future clinical development.
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Affiliation(s)
| | | | - Ken Ho
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | - Stacey Edick
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mei Song
- Microbicide Trials Network, Pittsburgh, Pennsylvania
| | - Yuqing Jiao
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Craig W Hendrix
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Craig Hoesley
- University of Alabama at Birmingham, Birmingham, Alabama
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Cramer RJ, Wright S, Wilsey CN, Kaniuka AR, Bowling J, Crocker T, Langhinrichsen-Rohling J, Montanaro E, Mennicke A, Heron KE. Alternative sexuality, sexual orientation and mobile technology: findings from the National Coalition for Sexual Freedom technology and health enhancement feasibility study. Psychology & Sexuality 2022. [DOI: 10.1080/19419899.2020.1777188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Robert J. Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Susan Wright
- National Coalition for Sexual Freedom, Baltimore, MD, USA
| | - Corrine N. Wilsey
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Andrea R. Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Tianca Crocker
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Erika Montanaro
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Annelise Mennicke
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kristin E. Heron
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
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Guthrie KM, Rosen RK, Guillen M, Ramirez JJ, Vargas SE, Fava JL, Ham AS, Katz DF, Cu-Uvin S, Tumilty S, Smith KA, Buckheit KW, Buckheit RW. Designing Dual Compartment HIV Prevention Products: Women's Sensory Perceptions and Experiences of Suppositories for Rectal and Vaginal Use. AIDS Res Hum Retroviruses 2021; 38:601-610. [PMID: 34544269 DOI: 10.1089/aid.2021.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dual compartment suppositories are being developed to prevent HIV and other sexually transmitted infections. Such products, for use in the rectum, the vagina, or both, could have a significant public health impact by decreasing global incidence of these diseases. In this study, 16 women each used two rheologically distinct suppositories in their vagina and rectum. User Sensory Perception and Experience (USPE) scales assessed sensory experiences during sexual activity to understand whether, and how, women perceive formulation properties in the vagina and rectum. Qualitative data from individual in-depth interviews captured women's descriptions and comparisons of the experiences. Significant differences and large Cohen's d effect sizes between vaginal and rectal experiences of suppository-A were found for three scales: Application (APP): Product Awareness, SEX: Initial Penetration; and SEX: Effortful. Qualitative data provided user experience details that credibly align with these score differences. Near significant differences and large effect sizes were found for two additional scales: SEX: Perceived Wetness with suppository-A and SEX: Messiness with suppository-B. In addition, other scale scores showed medium-to-large effect sizes that correspond to hypothesized sensations associated with biophysical properties of the suppositories. Statistical significance combined with large effect sizes and qualitative data accurately represent the hypothesized perceptibility of suppository properties and identifies performance characteristics relevant to acceptability and adherence; together these data provide discernment of factors that can guide the development of dual compartment products. The Clinical Trial Registration number: NCT02744261.
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Affiliation(s)
- Kate M. Guthrie
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Rochelle K. Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Melissa Guillen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Jaime J. Ramirez
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Sara E. Vargas
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph L. Fava
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | | | - David F. Katz
- Departments of Bioengineering and Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Susan Cu-Uvin
- Department of Obstetrics and Gynecology and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sheila Tumilty
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kelley A. Smith
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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Chakrapani V, Newman PA, Cameron M, Shunmugam M, Roungprakhon S, Rawat S, Baruah D, Nelson R, Tepjan S, Scarpa R. Willingness to Use Pre-exposure Prophylaxis (PrEP) and Preferences Among Men Who have Sex with Men in Mumbai and Chennai, India: A Discrete Choice Experiment. AIDS Behav 2021; 25:3074-84. [PMID: 33818643 DOI: 10.1007/s10461-021-03253-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 01/07/2023]
Abstract
Pre-exposure prophylaxis (PrEP) programs are planned for key populations in India. We examined PrEP awareness and willingness to use PrEP in order to support products and services for MSM. From December 2016 to March 2017, we conducted a survey and discrete choice experiment (DCE)-a technique to quantify the strength of participants' trade-off preferences among various product attributes-to assess willingness to use PrEP and related preferences. MSM were recruited from cruising sites and HIV prevention services in Mumbai and Chennai. DCE data were analyzed using mixed logit regression models and estimated marginal willingness-to-pay, the relative value participants' place on different PrEP attributes. Overall, 76.6% indicated willingness to use PrEP. Efficacy had the greatest effect on choice (high vs. moderate, aOR = 19.9; 95% CI 13.0-30.4), followed by dosing frequency (intermittent vs. daily regimen, aOR = 2.02; 95% CI 1.8-2.2). Participants preferred no (vs. minor) side-effects, subsidized (vs. market) price, and government (vs. private) hospitals. Findings suggest that educational and social marketing interventions should emphasize PrEP's high efficacy and minimal side effects, and programs should provide government-subsidized PrEP with choices of intermittent or daily dosing delivered by government and private hospitals/clinics in order to optimize PrEP uptake among MSM in India.
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Jhunjhunwala K, Dobard CW, Sharma S, Makarova N, Holder A, Dinh C, Mitchell J, Wang L, Zhang J, Patel SK, Heneine W, Rohan LC. Development, Characterization and In Vivo Pharmacokinetic Assessment of Rectal Suppositories Containing Combination Antiretroviral Drugs for HIV Prevention. Pharmaceutics 2021; 13:pharmaceutics13081110. [PMID: 34452070 PMCID: PMC8401959 DOI: 10.3390/pharmaceutics13081110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
Receptive anal intercourse (RAI) contributes significantly to HIV acquisition underscoring the need to develop HIV prevention options for populations engaging in RAI practices. We explored the feasibility of formulating rectal suppositories with potent antiviral drugs for on-demand use. A fixed-dose combination of tenofovir (TFV) and elvitegravir (EVG) (40 mg each) was co-formulated in six different suppository bases (three fat- and three water-soluble). Fat-soluble witepsol H15 and water-soluble polyethylene glycol (PEG) based suppositories demonstrated favorable in vitro release and were advanced to assess in vivo pharmacokinetics following rectal administration in macaques. In vivo drug release profiles were similar for both suppository bases. Median concentrations of TFV and EVG detected in rectal fluids at 2 h were 1- and 2-logs higher than the in vitro IC50, respectively; TFV-diphosphate levels in rectal tissues met or exceeded those associated with high efficacy against rectal simian HIV (SHIV) exposure in macaques. Leveraging on these findings, a PEG-based suppository with a lower dose combination of tenofovir alafenamide (TAF) and EVG (8 mg each) was developed and found to achieve similar rectal drug exposures in macaques. This study establishes the utility of rectal suppositories as a promising on-demand strategy for HIV PrEP and supports their clinical development.
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Affiliation(s)
- Kunal Jhunjhunwala
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.J.); (L.W.); (J.Z.); (S.K.P.)
- Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
| | - Charles W. Dobard
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.W.D.); (S.S.); (N.M.); (A.H.); (C.D.); (J.M.); (W.H.)
| | - Sunita Sharma
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.W.D.); (S.S.); (N.M.); (A.H.); (C.D.); (J.M.); (W.H.)
| | - Natalia Makarova
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.W.D.); (S.S.); (N.M.); (A.H.); (C.D.); (J.M.); (W.H.)
| | - Angela Holder
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.W.D.); (S.S.); (N.M.); (A.H.); (C.D.); (J.M.); (W.H.)
| | - Chuong Dinh
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.W.D.); (S.S.); (N.M.); (A.H.); (C.D.); (J.M.); (W.H.)
| | - James Mitchell
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.W.D.); (S.S.); (N.M.); (A.H.); (C.D.); (J.M.); (W.H.)
| | - Lin Wang
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.J.); (L.W.); (J.Z.); (S.K.P.)
- Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
| | - Junmei Zhang
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.J.); (L.W.); (J.Z.); (S.K.P.)
- Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
| | - Sravan Kumar Patel
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.J.); (L.W.); (J.Z.); (S.K.P.)
- Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
| | - Walid Heneine
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.W.D.); (S.S.); (N.M.); (A.H.); (C.D.); (J.M.); (W.H.)
| | - Lisa C. Rohan
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA; (K.J.); (L.W.); (J.Z.); (S.K.P.)
- Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
- Correspondence: ; Tel.: +1-412-641-6108
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Guthrie KM, Rosen RK, Vargas SE, Getz ML, Dawson L, Guillen M, Ramirez JJ, Baum MM, Vincent KL. User evaluations offer promise for pod-intravaginal ring as a drug delivery platform: A mixed methods study of acceptability and use experiences. PLoS One 2018; 13:e0197269. [PMID: 29758049 PMCID: PMC5951541 DOI: 10.1371/journal.pone.0197269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Effective HIV prevention requires efficient delivery of safe and efficacious drugs and optimization of user adherence. The user's experiences with the drug, delivery system, and use parameters are critical to product acceptability and adherence. Prevention product developers have the opportunity to directly control a drug delivery system and its impact on acceptability and adherence, as well as product efficacy. Involvement of potential users during preclinical design and development can facilitate this process. We embedded a mixed methods user evaluation study into a safety and pharmacokinetics (PK) trial of a pod-intravaginal ring delivering antiretroviral agents. METHODOLOGY Women enrolled in two cohorts, ultimately evaluating the safety/PK of a pod-IVRs delivering TDF-alone, TDF-FTC, and/or TDF-FTC-MVC. A 7-day use period was targeted for each pod-IVR, regardless of drug or drug combination. During the clinical study, participants provided both quantitative (i.e., survey) and qualitative (i.e., in-depth interview) data capturing acceptability, perceptibility, and adherence behaviors. Initial sexual and reproductive health history surveys, daily diaries, a final acceptability and willingness to use survey, and a qualitative in-depth interview comprised the user evaluation data for each pod-IVR experienced by the participants. FINDINGS Overall, the majority of participants (N = 10) reported being willing to use the pod-IVR platform for HIV prevention should it advance to market. Confidence to use the pod-IVR (e.g., insertion, removal) was high. There were no differences noted in the user experience of the pod-IVR platform; that is, whether the ring delivered TDF-alone, TDF-FTC, or TDF-FTC-MVC, users' experiences of the ring were similar and acceptable. Participants did report specific experiences, both sensory and behavioral, that impacted their use behaviors with respect to the ring, and which could ultimately impact acceptability and adherence. These experiences, and user evaluations elicited by them, could both challenge use or be used to leverage use in future trials and product rollout once fully articulated. CONCLUSIONS High willingness-to-use data and lack of salient differences in user experiences related to use of the pod-IVR platform (regardless of agents delivered) suggests that the pod-IVR is a feasible and acceptable drug delivery device in and of itself. This finding holds promise both for an anti-HIV pod-IVR and, potentially, a multipurpose prevention pod-IVR that could deliver both prevention for sexually transmitted infections (STIs) including HIV and contraception. Given the very early clinical trial context, further acceptability, perceptibility, and adherence data should continue to be explored, in the context of longer use periods (e.g., 28-day ring use), and in the contexts of sexual activity and menses. Using early design and development contexts to gain insights into potential challenges and facilitators of drug delivery systems such as the pod-IVR could save valuable resources and time as a potential biomedical technology moves through the clinical trial pipeline and into real-world use.
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Affiliation(s)
- Kate M. Guthrie
- The Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- * E-mail:
| | - Rochelle K. Rosen
- The Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Sara E. Vargas
- The Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Melissa L. Getz
- The Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Lauren Dawson
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Melissa Guillen
- The Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Jaime J. Ramirez
- The Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Marc M. Baum
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, California, United States of America
| | - Kathleen L. Vincent
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, United States of America
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Atujuna M, Newman PA, Wallace M, Eluhu M, Rubincam C, Brown B, Bekker LG. Contexts of vulnerability and the acceptability of new biomedical HIV prevention technologies among key populations in South Africa: A qualitative study. PLoS One 2018; 13:e0191251. [PMID: 29420549 PMCID: PMC5805172 DOI: 10.1371/journal.pone.0191251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/02/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND New biomedical prevention technologies (NPTs) may contribute to substantially reducing incident HIV infections globally. We explored acceptability and preferences for NPTs among key and other vulnerable populations in two South African townships. METHODS We conducted six focus groups and 12 in-depth interviews with adolescents, and adult heterosexual men, women, and men who have sex with men (MSM) (n = 48), and eight in-depth interviews with key informant healthcare workers. The interview guide described pre-exposure prophylaxis (PrEP), vaginal rings, rectal microbicides and HIV vaccines, and explored acceptability and product preferences. Focus groups and in-depth interviews (45-80 minutes) were conducted in Xhosa, audiotaped, and transcribed and translated into English. Data were coded and reviewed using framework analysis with NVivo software. RESULTS Overall, initial enthusiasm and willingness to use NPTs evolved into concerns about how particular NPTs might affect or require alterations in one's everyday lifestyle and practices. Different product preferences and motivations emerged by population based on similarity to existing practices and contexts of vulnerability. Adult women and female adolescents preferred a vaginal ring and HIV vaccine, motivated by longer duration of protection to mitigate feared repercussions from male partners, including threats to their marriage and safety, and a context of ubiquitous rape. Male adolescents preferred an HIV vaccine, seen as protection in serodiscordant relationships and convenient in obviating the HIV stigma and cost involved in buying condoms. Adult men preferred PrEP, given familiarity with oral medications and mistrust of injections, seen as enabling serodiscordant couples to have a child. MSM preferred a rectal microbicide given familiarity with gel-based lubricants, with concerns about duration of protection in the context of unplanned consensual sex and rape. CONCLUSIONS Biomedical interventions to prevent HIV transmission, rather than obviating social-structural factors that produce vulnerability, may be limited by these same factors. Implementation of NPTs should engage local communities to understand real-world constraints and strategise to deliver effective, multi-level combination prevention.
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Affiliation(s)
- Millicent Atujuna
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Wallace
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Megan Eluhu
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Clara Rubincam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ben Brown
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa
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Carballo-Diéguez A, Giguere R, Dolezal C, Leu CS, Balán IC, Brown W 3rd, Rael C, Richardson BA, Piper JM, Bekker LG, Chariyalertsak S, Chitwarakorn A, Gonzales P, Holtz TH, Liu A, Mayer KH, Zorrilla CD, Lama JR, McGowan I, Cranston RD; MTN-017 Protocol Team. Preference of Oral Tenofovir Disoproxil Fumarate/Emtricitabine Versus Rectal Tenofovir Reduced-Glycerin 1% Gel Regimens for HIV Prevention Among Cisgender Men and Transgender Women Who Engage in Receptive Anal Intercourse with Men. AIDS Behav 2017; 21:3336-45. [PMID: 29119473 DOI: 10.1007/s10461-017-1969-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Oral pre-exposure prophylaxis (PrEP) can prevent HIV transmission. Yet, some may prefer not to take systemic daily medication. MTN-017 was a 3-period, phase 2 safety and acceptability study of microbicide gel applied rectally either daily or before and after receptive anal intercourse (RAI), compared to daily oral tablet. At baseline, cisgender men and transgender women who reported RAI (N = 187) rated the daily oral regimen higher in overall liking, ease of use, and likelihood of future use than the gel regimens. After trying all three, 28% liked daily oral the least. Gel did not affect sexual enjoyment (88%) or improved it (7-8%). Most partners had no reaction to gel use. Ease of gel use improved significantly between the first and the last few times of daily use. A rectal gel used before and after RAI may constitute an attractive alternative to daily tablet. Experience with product use may increase acceptability.
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