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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] [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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Politch JA, Cu-Uvin S, Moench TR, Tashima KT, Marathe JG, Guthrie KM, Cabral H, Nyhuis T, Brennan M, Zeitlin L, Spiegel HML, Mayer KH, Whaley KJ, Anderson DJ. Safety, acceptability, and pharmacokinetics of a monoclonal antibody-based vaginal multipurpose prevention film (MB66): A Phase I randomized trial. PLoS Med 2021; 18:e1003495. [PMID: 33534791 PMCID: PMC7857576 DOI: 10.1371/journal.pmed.1003495] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND MB66 film is a multipurpose prevention technology (MPT) product with monoclonal antibodies (mAbs) against HIV-1 (VRC01-N) and HSV-1 and 2 (HSV8-N). The mAbs were produced by transient expression in Nicotiana benthamiana (N). We conducted a Phase I clinical trial to assess the safety, pharmacokinetics (PK), and ex vivo efficacy of single and repeated doses of MB66 when used intravaginally. METHODS AND FINDINGS The clinical trial enrolled healthy reproductive-aged, sexually abstinent women. In Segment A, 9 women received a single MB66 film which was inserted into the vaginal posterior fornix by a clinician. In Segment B, 29 women were randomly assigned to MB66 (Active) or Placebo film groups and were instructed to insert 1 film vaginally for 7 consecutive days. Visits and clinical sampling occurred predose and at various time points after single and repeated film doses. The primary endpoint was number of adverse events (AEs) Grade 2 or higher related to product use. Secondary endpoints included film dissolution rate, Nugent score (a Gram stain scoring system to diagnose bacterial vaginosis), vaginal pH, post-use survey results, cytokine concentrations in cervicovaginal lavage (CVL) specimens (assessed by Luminex assay), mAb concentrations in vaginal fluid collected from 4 sites (assessed by ELISA), and HIV and HSV neutralization activity of CVL samples ex vivo (assessed by TZM-bl and plaque reduction assay, respectively). The product was generally safe and well tolerated, with no serious AEs recorded in either segment. The AEs in this study were primarily genitourinary in nature with the most commonly reported AE being asymptomatic microscopic hematuria. There were no differences in vaginal pH or Nugent scores or significant increases in levels of proinflammatory cytokines for up to 7 days after film insertion in either segment or between Active and Placebo groups. Acceptability and willingness to use the product were judged to be high by post-use surveys. Concentrations of VRC01-N and HSV8-N in vaginal secretions were assessed over time to generate pharmacokinetic curves. Antibody levels peaked 1 hour postdosing with Active film (median: 35 μg/mL) and remained significantly elevated at 24 hours post first and seventh film (median: 1.8 μg/mL). Correcting for sample dilution (1:20), VRC01-N concentrations ranged from 36 to 700 μg/mL at the 24-hour time point, greater than 100-fold the IC50 for VRC01 (0.32 μg/mL); HSV8-N concentrations ranged from 80 to 601 μg/mL, well above the IC50 of 0.1 μg/m. CVL samples collected 24 hours after MB66 insertion significantly neutralized both HIV-1 and HSV-2 ex vivo. Study limitations include the small size of the study cohort, and the fact that no samples were collected between 24 hours and 7 days for pharmacokinetic evaluation. CONCLUSIONS Single and repeated intravaginal applications of MB66 film were safe, well tolerated, and acceptable. Concentrations and ex vivo bioactivity of both mAbs in vaginal secretions were significantly elevated and thus could provide protection for at least 24 hours postdose. However, further research is needed to evaluate the efficacy of MB66 film in women at risk for HIV and HSV infection. Additional antibodies could be added to this platform to provide protection against other sexually transmitted infections (STIs) and contraception. TRIAL REGISTRATION ClinicalTrials.gov NCT02579083.
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Affiliation(s)
- Joseph A. Politch
- Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, United States of America
| | - Susan Cu-Uvin
- Alpert Medical School of Brown University, Department of Obstetrics and Gynecology and Medicine, Providence, Rhode Island, United States of America
| | - Thomas R. Moench
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Karen T. Tashima
- Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Jai G. Marathe
- Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, United States of America
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Tara Nyhuis
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Miles Brennan
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Larry Zeitlin
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Hans M. L. Spiegel
- Kelly Government Solutions, Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, United States of America
| | - Kenneth H. Mayer
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, United States of America
| | - Kevin J. Whaley
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Deborah J. Anderson
- Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, United States of America
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Guthrie KM, Fava JL, Vargas SE, Rosen RK, Shaw JG, Kojic EM, Ham AS, Rohan LC, Katz D, Panameño A, Colleran C, Friend DF, Buckheit KW, Buckheit RW. The Role of Volume in the Perceptibility of Topical Vaginal Formulations: User Sensory Perceptions and Experiences of Heterosexual Couples During Vaginal Sex. AIDS Res Hum Retroviruses 2020; 36:1059-1070. [PMID: 32988214 DOI: 10.1089/aid.2020.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Users' sensory perceptions and experiences (USPEs; perceptibility) of drug formulations can critically impact product adoption and adherence, especially when products rely on appropriate user behaviors (timing of administration, dosing measurement) for effectiveness. The use of topical gel formulations for effective antihuman immunodeficiency virus/sexually transmitted infection (HIV/STI) vaginal microbicides has been associated with messiness and other use-associated challenges, resulting in low adherence. Nonetheless, such formulations remain attractive due to good pharmacokinetics and resulting pharmacodynamics through their volume and surface contact for drug delivery into luminal fluids and mucosa. Consequently, advocates and scientists continue to pursue topical forms [semisolid (e.g., gel, suppository); solid (e.g., film)] to deliver select drugs and offer user choice in HIV/STI prevention. The current data build on previously validated USPE scales evaluating perceptibility of gels with various biophysical/rheological properties. Specifically, increased formulation parameter space adds a new set of properties inherent in quick-dissolving film. We compared film, a product adding no discernable volume to the vaginal environment, to 2 and 3.5 mL hydroxyethyl cellulose gel to consider the impact of volume on user experience. We also examined the USPE scales for evaluation of male sexual partners' experiences. The original USPE scales functioned as expected. Additionally, six new USPE scales were identified in this enhanced parameter space. Significant differences were noted between USPEs in pairwise comparisons, with largest differences between film and high-volume gel. Product developers and behavioral scientists can use these scales to design products, optimizing user experience and maximizing adherence and delivery of efficacious anti-HIV/STI pharmaceuticals. They can be extended to evaluation of additional formulations, devices, and compartments, as well as single- and multipurpose pharmaceuticals. In broader contexts, USPEs could be of value in evaluating formulations and devices to prevent/treat other diseases (e.g., ophthalmologic, dermatologic). Steadfast attention should be given to patient experience, and, where applicable, experiences of partners and/or caregivers.
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Affiliation(s)
- Kate M. Guthrie
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joseph L. Fava
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Sara E. Vargas
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rochelle K. Rosen
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Julia G. Shaw
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Erna M. Kojic
- Division of Infectious Disease, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Lisa C. Rohan
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Katz
- Department of Bioengineering, Duke University, Durham, North Carolina, USA
- Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina, USA
| | - Anacecilia Panameño
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Christopher Colleran
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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4
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Vargas SE, Midoun MM, Guillen M, Getz ML, Underhill K, Kuo C, Guthrie KM. A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 45:25-34. [PMID: 31592770 DOI: 10.1363/45e7619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CONTEXT Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.
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Affiliation(s)
- Sara E Vargas
- Research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI,
| | - Miriam M Midoun
- Graduate student, Department of Comparative Human Development, University of Chicago
| | - Melissa Guillen
- Project director, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | | | - Kristen Underhill
- Associate professor, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York
| | - Caroline Kuo
- Associate professor (research), Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Kate M Guthrie
- Senior research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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5
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Optimization and Application of In Vitro and Ex Vivo Models for Vaginal Semisolids Safety Evaluation. J Pharm Sci 2019; 108:3289-3301. [DOI: 10.1016/j.xphs.2019.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/19/2019] [Accepted: 05/21/2019] [Indexed: 02/05/2023]
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6
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Vargas SE, Midoun MM, Guillen M, Getz ML, Underhill K, Kuo C, Guthrie KM. A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:71-80. [PMID: 31108027 PMCID: PMC6662569 DOI: 10.1363/psrh.12103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/28/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.
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Affiliation(s)
- Sara E. Vargas
- Research scientist, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Miriam M. Midoun
- Graduate student, Department of Comparative Human Development, University of Chicago
| | - Melissa Guillen
- Project director, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | | | - Kristen Underhill
- Associate professor, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York
| | - Caroline Kuo
- Associate professor (research), Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence
| | - Kate M. Guthrie
- Senior research, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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Bakke AJ, Zaveri T, Ziegler GR, Hayes JE. Using sensory and consumer science in drug delivery system optimization: mixed methods in women of color as a case study. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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8
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Effects of gel volume on pharmacokinetics for vaginal and rectal applications of combination DuoGel-IQB4012, a dual chamber-dual drug HIV microbicide gel, in pigtailed macaques. Drug Deliv Transl Res 2018; 8:1180-1190. [PMID: 29761350 DOI: 10.1007/s13346-018-0538-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study evaluated effects of differing gel volumes on pharmacokinetics (PK). IQB4012, a gel containing the non-nucleoside reverse transcriptase inhibitor IQP-0528 and tenofovir (TFV), was applied to the pigtailed macaque vagina and rectum. Vaginal gel volumes (1% loading of both drugs) were 0.5 or 1.5 ml; following wash-out, 1 or 4 ml of gel were then applied rectally. Blood, vaginal, and rectal fluids were collected at 0, 2, 4, and 24 h. Vaginal and rectal tissue biopsies were collected at 4 and 24 h. There were no statistically significant differences in concentrations for either drug between gel volumes within compartments at matched time points. After vaginal gel application, median IQP-0528 concentrations were ~ 104-105 ng/g, 105-106 ng/ml, and 103-105 ng/ml in vaginal tissues, vaginal fluids, and rectal fluids, respectively (over 24 h). Median vaginal TFV concentrations were 1-2 logs lower than IQP-0528 levels at matched time points. After rectal gel application, median IQP-0528 and TFV concentrations in rectal fluids were ~ 103-105 ng/ml and ~ 102-103 ng/ml, respectively. Concentrations of both drugs sampled in rectal tissues were low (~ 101-103 ng/g). For 1 ml gel, half of sampled rectal tissues had undetectable concentrations of either drug, and over half of sampled rectal fluids had undetectable TFV concentrations. These results indicate differences in drug delivery between the vaginal and rectal compartments, and that smaller vaginal gel volumes may not significantly compromise microbicide PK and prophylactic potential. However, effects of rectal gel volume on PK for both drugs were less definitive.
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Zaveri T, Powell KA, Guthrie KM, Bakke AJ, Ziegler GR, Hayes JE. Qualitative exploration of intrinsic and extrinsic factors that influence acceptability of semisoft vaginal suppositories. BMC Womens Health 2018; 18:170. [PMID: 30342510 PMCID: PMC6195955 DOI: 10.1186/s12905-018-0657-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/30/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vaginal microbicides are a promising means to prevent the transmission of HIV and other sexually transmitted infections, by empowering women to initiate use prophylactically when they perceive themselves to be at risk. However, in clinical trials, microbicides have shown mixed results, with the consistent finding that effectiveness varies substantially as a function of user adherence. METHODS Based on the assumption that adherence is driven, at least in part, by product properties that influence acceptability, we used softgel technology to develop vaginal drug delivery systems in the intermediate texture space between solids and liquids to overcome potential shortcomings of current dosage forms. Here, we used focus groups and surveys to determine women's initial reactions (i.e., acceptance and willingness-to-try) for semisoft vaginal suppositories intended for HIV and STI prevention, with a specific focus on how perception of and preferences for vaginal suppositories may be influenced by product characteristics such as size, shape, and firmness. RESULTS Via focus groups, we identified intrinsic and extrinsic factors relevant to acceptability of semisoft suppository prototypes. Willingness-to-try depended on factors like intended functionality, anticipated leakage, type of sex, recommended frequency of use, type of sexual partner, and perceived risk. When handled ex vivo, shape, size, and firmness of suppositories communicated information about ease of imagined insertion and handling, perceived effectiveness, anticipated awareness and comfort of the product in the body. These impressions were partly based on prior experience with vaginal products. CONCLUSIONS Sensory attributes appear to play a substantial role in women's preferences and willingness to try the semisoft suppositories. Using these methods during preclinical development should help efficiently optimize a final product that is both biologically efficacious and preferred by women, toward a goal of enhancing adherence and effectiveness.
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Affiliation(s)
- Toral Zaveri
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - Kimberly A Powell
- College of Education, The Pennsylvania State University, University Park, PA 16802 USA
- College of Arts and Architecture, The Pennsylvania State University, University Park, PA 16802 USA
| | - Kate M Guthrie
- Centers for Behavioral & Preventive Medicine, the Miriam Hospital, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02906 USA
| | - Alyssa J Bakke
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - Gregory R Ziegler
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - John E Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA 16802 USA
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Guthrie KM, Rosen RK, Vargas SE, Guillen M, Steger AL, Getz ML, Smith KA, Ramirez JJ, Kojic EM. User input in iterative design for prevention product development: leveraging interdisciplinary methods to optimize effectiveness. Drug Deliv Transl Res 2018; 7:761-770. [PMID: 28653286 DOI: 10.1007/s13346-017-0397-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The development of HIV-preventive topical vaginal microbicides has been challenged by a lack of sufficient adherence in later stage clinical trials to confidently evaluate effectiveness. This dilemma has highlighted the need to integrate translational research earlier in the drug development process, essentially applying behavioral science to facilitate the advances of basic science with respect to the uptake and use of biomedical prevention technologies. In the last several years, there has been an increasing recognition that the user experience, specifically the sensory experience, as well as the role of meaning-making elicited by those sensations, may play a more substantive role than previously thought. Importantly, the role of the user-their sensory perceptions, their judgements of those experiences, and their willingness to use a product-is critical in product uptake and consistent use post-marketing, ultimately realizing gains in global public health. Specifically, a successful prevention product requires an efficacious drug, an efficient drug delivery system, and an effective user. We present an integrated iterative drug development and user experience evaluation method to illustrate how user-centered formulation design can be iterated from the early stages of preclinical development to leverage the user experience. Integrating the user and their product experiences into the formulation design process may help optimize both the efficiency of drug delivery and the effectiveness of the user.
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Affiliation(s)
- Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA. .,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-A1, Providence, RI, 02912, USA.
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Sara E Vargas
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-A1, Providence, RI, 02912, USA
| | - Melissa Guillen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Arielle L Steger
- Department of Bioengineering, University of Washington, 3720 15th Avenue NE, Seattle, WA, 98195, USA
| | - Melissa L Getz
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Kelley A Smith
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Jaime J Ramirez
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Erna M Kojic
- Division of Infectious Disease, Department of Medicine, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
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11
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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] [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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Innovative sensory methods to access acceptability of mixed polymer semisoft ovules for microbicide applications. Drug Deliv Transl Res 2018; 6:551-64. [PMID: 27357703 DOI: 10.1007/s13346-016-0309-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Vaginal microbicides are a promising means to prevent the transmission of HIV, empowering women by putting protection under their control. We have been using gel technology to develop microbicides in the intermediate texture space to overcome shortcomings of current solid and liquid forms. We recently formulated semisoft ovules from mixed polymer combinations of carrageenan and Carbopol 940P to overcome some of the flaws with our previous generation of formulations based solely on carrageenan. To determine the user acceptability of the reformulated gels, women first evaluated intact semisoft ovules before evaluating ovules that had been subjected to mechanical crushing to simulate samples that represent post-use discharge. Women then evaluated combinations of intact and discharge samples to understand how ovule textures correlated with texture of the resulting discharge samples. Carbopol concentration directly and inversely correlated with willingness to try for discharge samples and intact samples, respectively. When evaluating intact samples, women focused on the ease of inserting the product and preferred firmer samples; conversely, when evaluating discharge samples, softer samples that resulted in a smooth paste were preferred. Significant differences between samples were lost when evaluating pairs as women made varying trade-offs between their preference for ease of inserting intact ovules and acceptability of discharge appearance. Evaluating samples that represent different stages of the use cycle reveals a more holistic measure of product acceptability. Studying sensory acceptability in parallel with biophysical performance enables an iterative design process that considers what women prefer in terms of insertion as well as possibility of leakage.
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13
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Guthrie KM, Rohan L, Rosen RK, Vargas SE, Shaw JG, Katz D, Kojic EM, Ham AS, Friend D, Buckheit KW, Buckheit RW. Vaginal film for prevention of HIV: using visual and tactile evaluations among potential users to inform product design. Pharm Dev Technol 2017; 23:311-314. [PMID: 28592183 DOI: 10.1080/10837450.2017.1339085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Topical prevention of HIV and other STIs is a global health priority. To provide options for users, developers have worked to design safe, effective and acceptable vaginal dissolving film formulations. We aimed to characterize user experiences of vaginal film size, texture and color, and their role in product-elicited sensory perceptions (i.e. perceptibility), acceptability and willingness to use. In the context of a user-centered product evaluation study, we elicited users' 'first impressions' of various vaginal film formulation designs via visual and tactile prototype inspection during a qualitative user evaluation interview. Twenty-four women evaluated prototypes. Participants considered size and texture to be important for easy insertion. Color was more important following dissolution than prior to insertion. When asked to combine and balance all properties to arrive at an ideal film, previously stated priorities for individual characteristics sometimes shifted, with the salience of some individual characteristics lessening when multiple characteristics were weighted in combination. While first impressions alone may not drive product uptake, users' willingness to initially try a product is likely impacted by such impressions. Developers should consider potential users' experiences and preferences in vaginal film design. This user-focused approach is useful for characterizing user sensory perceptions and experiences relevant to early design of prevention technologies.
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Affiliation(s)
- K M Guthrie
- a Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA.,b Department of Psychiatry and Human Behavior , The Warren Alpert Medical School of Brown University , Providence , RI , USA.,c Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - L Rohan
- d Magee-Womens Research Institute , Pittsburgh , PA , USA.,e University of Pittsburgh , Pittsburgh , PA , USA
| | - R K Rosen
- a Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA.,c Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - S E Vargas
- a Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA.,b Department of Psychiatry and Human Behavior , The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - J G Shaw
- a Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA
| | - D Katz
- f Biomedical Engineering and Obstetrics/Gynecology, Duke University , Durham , NC , USA
| | - E M Kojic
- g Division of Immunology , The Miriam Hospital , Providence , RI , USA
| | - A S Ham
- h ImQuest BioSciences, Inc , Frederick , MD , USA
| | | | - K W Buckheit
- h ImQuest BioSciences, Inc , Frederick , MD , USA
| | - R W Buckheit
- h ImQuest BioSciences, Inc , Frederick , MD , USA
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14
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Weld ED, Hiruy H, Guthrie KM, Fava JL, Vargas SE, Buckheit K, Buckheit R, Spiegel H, Breakey J, Fuchs EJ, Hendrix CW. A Comparative Pre-Phase I Study of the Impact of Gel Vehicle Volume on Distal Colon Distribution, User Experience, and Acceptability. AIDS Res Hum Retroviruses 2017; 33:440-447. [PMID: 27824253 DOI: 10.1089/aid.2016.0167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
For persons at risk of HIV infection who practice receptive anal intercourse (RAI), topical rectal microbicides represent a promising option for coitally dependent protection. The study compared colorectal distribution and user sensory experiences of two different volumes of rectal gel for suitability as rectal microbicide. Eight HIV-negative men with a history of recent RAI were enrolled into a two-period, sequence-randomized dosing study comparing 3.5 and 10 ml of radiolabeled (1 mCi 99mTc-DTPA) universal placebo, hydroxyethyl cellulose gel. Each participant received two doses in the research unit, one of each volume, separated by a washout period of at least 2 weeks. Each research unit dose was followed by a self-administered take-home dose in the context of preparing for RAI. Safety and gastrointestinal distribution were assessed after the research unit doses, safety, perceptibility, and acceptability, were assessed after take-home doses. There were no adverse effects of Grade 2 or higher and all resolved spontaneously. Both volumes were well tolerated and received high acceptability scores. Perceptibility scores showed meaningful effect size differences ranging from Cohen's d = 0.5 to d = 1.2. The 3.5 and 10 ml gel volumes distributed similarly (p > .2) within the rectosigmoid, ranging from 0.69 to 18.84 cm and 1.21 to 19.01 cm from the anorectal junction, respectively. Both volumes covered the typical gastrointestinal distribution of ejaculate following simulated intercourse based on other studies. Either of these gel volumes could reasonably be pursued for the next phase of development of rectal microbicides.
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Affiliation(s)
- Ethel D Weld
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 2 Department of Medicine (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Hiwot Hiruy
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 Department of Pediatrics (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Kate Morrow Guthrie
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
- 5 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University . Providence, Rhode Island
| | - Joseph L Fava
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
| | - Sara E Vargas
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
- 5 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University . Providence, Rhode Island
| | | | | | | | - Jennifer Breakey
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Edward J Fuchs
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Craig W Hendrix
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 2 Department of Medicine (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
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15
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Duby Z, Mensch B, Hartmann M, Montgomery E, Mahaka I, Bekker LG, van der Straten A. Achieving the optimal vaginal state: using vaginal products and study gels in Uganda, Zimbabwe, and South Africa. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2017; 29:247-257. [PMID: 30519370 PMCID: PMC6276804 DOI: 10.1080/19317611.2017.1297754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Preferences and practices related to the vaginal condition have implications for the use of vaginal HIV prevention products. We used qualitative methods to explore narratives relating to the vaginal state amongst women in South Africa, Uganda and Zimbabwe who had previously participated in a biomedical HIV prevention trial. We investigated women's behaviours related to optimising the vaginal state, experiences and perceptions of the gel's effect on the vaginal state and on penile-vaginal intercourse, women's narratives on male partner perceptions, and how preferences relating to the vaginal state may have interfered with gel use.
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Affiliation(s)
- Zoe Duby
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | | | - Miriam Hartmann
- Women’s Global Health Imperative, RTI International, San Francisco, CA, USA
| | | | - Imelda Mahaka
- UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | - Ariane van der Straten
- Women’s Global Health Imperative, RTI International, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
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16
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Guthrie KM, Dunsiger S, Vargas SE, Fava JL, Shaw JG, Rosen RK, Kiser PF, Kojic EM, Friend DR, Katz DF. Perceptibility and the "Choice Experience": User Sensory Perceptions and Experiences Inform Vaginal Prevention Product Design. AIDS Res Hum Retroviruses 2016; 32:1022-1030. [PMID: 26942455 DOI: 10.1089/aid.2015.0275] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The development of pericoital (on demand) vaginal HIV prevention technologies remains a global health priority. Clinical trials to date have been challenged by nonadherence, leading to an inability to demonstrate product efficacy. The work here provides new methodology and results to begin to address this limitation. We created validated scales that allow users to characterize sensory perceptions and experiences when using vaginal gel formulations. In this study, we sought to understand the user sensory perceptions and experiences (USPEs) that characterize the preferred product experience for each participant. Two hundred four women evaluated four semisolid vaginal formulations using the USPE scales at four randomly ordered formulation evaluation visits. Women were asked to select their preferred formulation experience for HIV prevention among the four formulations evaluated. The scale scores on the Sex-associated USPE scales (e.g., Initial Penetration and Leakage) for each participant's selected formulation were used in a latent class model analysis. Four classes of preferred formulation experiences were identified. Sociodemographic and sexual history variables did not predict class membership; however, four specific scales were significantly related to class: Initial Penetration, Perceived Wetness, Messiness, and Leakage. The range of preferred user experiences represented by the scale scores creates a potential target range for product development, such that products that elicit scale scores that fall within the preferred range may be more acceptable, or tolerable, to the population under study. It is recommended that similar analyses should be conducted with other semisolid vaginal formulations, and in other cultures, to determine product property and development targets.
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Affiliation(s)
- Kate Morrow Guthrie
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Shira Dunsiger
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Sara E. Vargas
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joseph L. Fava
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Julia G. Shaw
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Rochelle K. Rosen
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Patrick F. Kiser
- Department of Bioengineering, University of Utah, Salt Lake City, Utah
| | - E. Milu Kojic
- Immunology Center, The Miriam Hospital, Providence, Rhode Island
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - David F. Katz
- Departments of Biomedical Engineering & Obstetrics/Gynecology, Duke University, Durham, North Carolina
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17
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The Promise of Intravaginal Rings for Prevention: User Perceptions of Biomechanical Properties and Implications for Prevention Product Development. PLoS One 2015; 10:e0145642. [PMID: 26695431 PMCID: PMC4690611 DOI: 10.1371/journal.pone.0145642] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
Intravaginal rings (IVRs) are currently under investigation as devices for the delivery of agents to protect against the sexual transmission of HIV and STIs, as well as pregnancy. To assist product developers in creating highly acceptable rings, we sought to identify characteristics that intravaginal ring users consider when making decisions about ring use or non-use. We conducted four semi-structured focus groups with 21 women (aged 18-45) who reported using an IVR in the past 12 months. Participants manipulated four prototype rings in their hands, discussed ring materials, dimensionality, and "behavior," and shared perceptions and appraisals. Five salient ring characteristics were identified: 1) appearance of the rings' surfaces, 2) tactile sensations of the cylinder material, 3) materials properties, 4) diameter of the cylinder, and 5) ring circumference. Pliability (or flexibility) was generally considered the most important mechanical property. Several ring properties (e.g., porousness, dimensionality) were associated with perceptions of efficacy. Women also revealed user behaviors that may impact the effectiveness of certain drugs, such as removing, rinsing and re-inserting the ring while bathing, and removing the ring during sexual encounters. As product developers explore IVRs as prevention delivery systems, it is critical to balance product materials and dimensions with use parameters to optimize drug delivery and the user experience. It is also critical to consider how user behaviors (e.g., removing the ring) might impact drug delivery.
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18
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Nelson AG, Zhang X, Ganapathi U, Szekely Z, Flexner CW, Owen A, Sinko PJ. Drug delivery strategies and systems for HIV/AIDS pre-exposure prophylaxis and treatment. J Control Release 2015; 219:669-680. [PMID: 26315816 PMCID: PMC4879940 DOI: 10.1016/j.jconrel.2015.08.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 01/08/2023]
Abstract
The year 2016 will mark an important milestone - the 35th anniversary of the first reported cases of HIV/AIDS. Antiretroviral Therapy (ART) including Highly Active Antiretroviral Therapy (HAART) drug regimens is widely considered to be one of the greatest achievements in therapeutic drug research having transformed HIV infection into a chronically managed disease. Unfortunately, the lack of widespread preventive measures and the inability to eradicate HIV from infected cells highlight the significant challenges remaining today. Moving forward there are at least three high priority goals for anti-HIV drug delivery (DD) research: (1) to prevent new HIV infections from occurring, (2) to facilitate a functional cure, i.e., when HIV is present but the body controls it without drugs and (3) to eradicate established infection. Pre-exposure Prophylaxis (PrEP) represents a significant step forward in preventing the establishment of chronic HIV infection. However, the ultimate success of PrEP will depend on achieving sustained antiretroviral (ARV) tissue concentrations and will require strict patient adherence to the regimen. While first generation long acting/extended release (LA/ER) DD Systems (DDS) currently in development show considerable promise, significant DD treatment and prevention challenges persist. First, there is a critical need to improve cell specificity through targeting in order to selectively achieve efficacious drug concentrations in HIV reservoir sites to control/eradicate HIV as well as mitigate systemic side effects. In addition, approaches for reducing cellular efflux and metabolism of ARV drugs to prolong effective concentrations in target cells need to be developed. Finally, given the current understanding of HIV pathogenesis, next generation anti-HIV DDS need to address selective DD to the gut mucosa and lymph nodes. The current review focuses on the DDS technologies, critical challenges, opportunities, strategies, and approaches by which novel delivery systems will help iterate towards prevention, functional cure and eventually the eradication of HIV infection.
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Affiliation(s)
- Antoinette G Nelson
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Xiaoping Zhang
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Usha Ganapathi
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Zoltan Szekely
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Charles W Flexner
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Andrew Owen
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Patrick J Sinko
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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19
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Woodsong C, Holt JDS. Acceptability and preferences for vaginal dosage forms intended for prevention of HIV or HIV and pregnancy. Adv Drug Deliv Rev 2015; 92:146-54. [PMID: 25703190 DOI: 10.1016/j.addr.2015.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/22/2015] [Accepted: 02/06/2015] [Indexed: 11/28/2022]
Abstract
This paper reviews key issues found to affect acceptability and preferences for vaginal products to prevent HIV infection or HIV and pregnancy. We focus on the interplay between the biological and physico-chemical aspects of formulation and the social and behavioral issues that may affect use. The need for an HIV prevention product that women can use is driven by women's increased biological and social vulnerability to HIV infection, and thus social and behavioral research on microbicide acceptability has been conducted alongside, as well as separate from, the earliest product development efforts. Some acceptability and preference issues are specific to a product's dosage form, use-requirements, and/or use indications, while others pertain to any vaginal product used for prevention of HIV or pregnancy. Although most of the work cited here was published since 2010, it draws on a much longer trajectory of research.
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MESH Headings
- Administration, Intravaginal
- Anti-HIV Agents/administration & dosage
- Anti-HIV Agents/adverse effects
- Anti-HIV Agents/pharmacokinetics
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/pharmacokinetics
- Drug Delivery Systems/methods
- Female
- HIV Infections/prevention & control
- Humans
- Patient Preference
- Pregnancy
- Pregnancy, Unplanned
- Vagina/physiology
- Vaginal Absorption
- Vaginal Creams, Foams, and Jellies/administration & dosage
- Vaginal Creams, Foams, and Jellies/adverse effects
- Vaginal Creams, Foams, and Jellies/pharmacokinetics
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Affiliation(s)
- Cynthia Woodsong
- International Partnership for Microbicides, 8401 Colesville Rd., Ste 200, Silver Spring MD 20910, USA.
| | - Jonathon D S Holt
- International Partnership for Microbicides, 8401 Colesville Rd., Ste 200, Silver Spring MD 20910, USA
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20
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Katz DF, Yuan A, Gao Y. Vaginal drug distribution modeling. Adv Drug Deliv Rev 2015; 92:2-13. [PMID: 25933938 PMCID: PMC4600641 DOI: 10.1016/j.addr.2015.04.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/14/2015] [Accepted: 04/21/2015] [Indexed: 01/03/2023]
Abstract
This review presents and applies fundamental mass transport theory describing the diffusion and convection driven mass transport of drugs to the vaginal environment. It considers sources of variability in the predictions of the models. It illustrates use of model predictions of microbicide drug concentration distribution (pharmacokinetics) to gain insights about drug effectiveness in preventing HIV infection (pharmacodynamics). The modeling compares vaginal drug distributions after different gel dosage regimens, and it evaluates consequences of changes in gel viscosity due to aging. It compares vaginal mucosal concentration distributions of drugs delivered by gels vs. intravaginal rings. Finally, the modeling approach is used to compare vaginal drug distributions across species with differing vaginal dimensions. Deterministic models of drug mass transport into and throughout the vaginal environment can provide critical insights about the mechanisms and determinants of such transport. This knowledge, and the methodology that obtains it, can be applied and translated to multiple applications, involving the scientific underpinnings of vaginal drug distribution and the performance evaluation and design of products, and their dosage regimens, that achieve it.
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Affiliation(s)
- David F Katz
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Obstetrics and Gynecology, Duke University, Durham, NC USA.
| | - Andrew Yuan
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Yajing Gao
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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Rosen RK, van den Berg JJ, Vargas SE, Senocak N, Shaw JG, Buckheit RW, Smith KA, Guthrie KM. Meaning-making matters in product design: users' sensory perceptions and experience evaluations of long-acting vaginal gels and intravaginal rings. Contraception 2015; 92:596-601. [PMID: 26276246 DOI: 10.1016/j.contraception.2015.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Users' sensory perceptions and experiences of intravaginal products can inform acceptability and adherence. Focusing on the meanings women derive from formulation/device characteristics facilitates developers' design iterations toward optimizing user experience. We investigated how users of long-acting gels and intravaginal rings (IVRs) impute meaning to characteristics that may affect future product use. STUDY DESIGN Focus groups were conducted with contraceptive IVR and vaginal lubricant users. Current perceptibility science and historical theory on the cultural acceptability of fertility regulating methods informed the analysis. RESULTS A total of 21 IVR users and 29 lubricant users attended focus groups in which they manipulated products in their hands and discussed reactions to product characteristics. Participants used prior product experiences and sensory perceptions of prototype manipulations to inform meanings about product properties and performance for pregnancy, disease prevention, comfort, and perceived efficacy. The meanings derived from product characteristics depended on why the product would be used; a characteristic deemed problematic in one risk context may be considered preferable in another. CONCLUSIONS Intravaginal product users create narratives that ascribe influence or causality to product characteristics. These meanings, whether correct or incorrect biologically, will shape vaginal product acceptability, use, and effectiveness. IMPLICATIONS Long-acting and sustained-release drug delivery systems will be part of the multipurpose prevention continuum. Developers must consider how sensory experiences and culturally salient assumptions shape the meanings users make of product design characteristics. Those meanings will ultimately impact use and effectiveness.
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Affiliation(s)
- Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02906, USA.
| | - Jacob J van den Berg
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
| | - Sara E Vargas
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
| | - Natali Senocak
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA.
| | - Julia G Shaw
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA.
| | - Robert W Buckheit
- ImQuest BioSciences, Inc., 7340 Executive Way, Suite R, Frederick, MD 21704, USA.
| | - Kelley Alison Smith
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA.
| | - Kate Morrow Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
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22
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Gao Y, Yuan A, Chuchuen O, Ham A, Yang KH, Katz DF. Vaginal deployment and tenofovir delivery by microbicide gels. Drug Deliv Transl Res 2015; 5:279-94. [PMID: 25874971 PMCID: PMC4420798 DOI: 10.1007/s13346-015-0227-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Gels are one of the soft material platforms being evaluated to deliver topically acting anti-HIV drugs (microbicides) to the vaginal environment. For each drug, its loaded concentration, gel properties and applied volume, and frequency of dosing can be designed to optimize PK and, thence, PD. These factors also impact user sensory perceptions and acceptability. Deterministic compartmental modeling of vaginal deployment and drug delivery achieved by test gels can help delineate how multiple parameters characterizing drug, vehicle, vaginal environment, and dosing govern details of PK and PD and also gel leakage from the canal. Such microbicide delivery is a transport process combining convection, e.g., from gel spreading along the vaginal canal, with drug diffusion in multiple compartments, including gel, mucosal epithelium, and stroma. The present work builds upon prior models of gel coating flows and drug diffusion (without convection) in the vaginal environment. It combines and extends these initial approaches in several key ways, including: (1) linking convective drug transport due to gel spreading with drug diffusion and (2) accounting for natural variations in dimensions of the canal and the site of gel placement therein. Results are obtained for a leading microbicide drug, tenofovir, delivered by three prototype microbicide gels, with a range of rheological properties. The model includes phosphorylation of tenofovir to tenofovir diphosphate (which manifests reverse transcriptase activity in host cells), the stromal concentration distributions of which are related to reference prophylactic values against HIV. This yields a computed summary measure related to gel protection ("percent protected"). Analyses illustrate tradeoffs amongst gel properties, drug loading, volume and site of placement, and vaginal dimensions, in the time and space history of gel distribution and tenofovir transport to sites of its anti-HIV action and concentrations and potential prophylactic actions of tenofovir diphosphate therein.
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Affiliation(s)
- Y Gao
- Department of Biomedical Engineering, Duke University, Room 136 Hudson Hall, Box 90281, Durham, NC, 27708, USA,
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23
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Morrow KM, Underhill K, van den Berg JJ, Vargas S, Rosen RK, Katz DF. User-identified gel characteristics: a qualitative exploration of perceived product efficacy of topical vaginal microbicides. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1459-1467. [PMID: 24452632 PMCID: PMC4327860 DOI: 10.1007/s10508-013-0235-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 11/12/2013] [Accepted: 11/15/2013] [Indexed: 06/03/2023]
Abstract
Research has demonstrated that certain vaginal gel products--microbicides containing antiretroviral drugs--may reduce HIV infection risk among women. But for vaginal gels to avert HIV and other sexually transmitted infections (STIs), at-risk women must be willing to use them as directed. These products must therefore be "acceptable" to women and an important component of acceptability is users' perception that the product will work to prevent infection. We sought to understand how women's perceptions of vaginal gel properties may shape their understanding of product efficacy for HIV and STI prevention. Sixteen women completed two in-depth qualitative interviews (k = 32) to identify the range and types of sensory perceptions they experienced when using two vaginal gels. We identified emergent themes and linkages between users' sensory perceptions and their beliefs about product efficacy. Users' predictions about product efficacy for preventing infection corresponded to measurable physical properties, including gel volume, location in the vagina, coating behavior, sensation of the gel in the vagina, leakage, and gel changes during coital acts. Although the women described similar sensory experiences (e.g., gel leaked from the vagina), they interpreted these experiences to have varying implications for product efficacy (e.g., leakage was predicted to increase or decrease efficacy). To improve microbicide acceptability, gel developers should investigate and deliberately incorporate properties that influence users' perceptions of efficacy. When a microbicide is approved for use, providers should educate users to anticipate and understand their sensory experiences; improving users' experience can maximize adherence and product effectiveness.
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Affiliation(s)
- Kathleen M Morrow
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, The Miriam Hospital and Warren Alpert Medical School of Brown University, Coro West, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA,
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24
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Firmness Perception Influences Women's Preferences for Vaginal Suppositories. Pharmaceutics 2014; 6:512-29. [PMID: 25211123 PMCID: PMC4190533 DOI: 10.3390/pharmaceutics6030512] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/23/2014] [Accepted: 08/26/2014] [Indexed: 11/16/2022] Open
Abstract
Microbicides are being actively researched and developed as woman-initiated means to prevent HIV transmission during unprotected coitus. Along with safety and efficacy, assessing and improving compliance is a major area of research in microbicide development. We have developed carrageenan-based semisoft vaginal suppositories and have previously evaluated how physical properties such as firmness, size and shape influence women’s willingness to try them. Firmness has previously been quantified in terms of small-strain storage modulus, G’, however large-strain properties of the gels may also play a role in the firmness perception. In the current study we prepared two sets of suppositories with the same G’ but different elongation properties at four different G’ values (250, 2500, 12,500, 25,000 Pa): For convenience we refer to these as “brittle” and “elastic”, although these terms were never provided to study participants. In the first of two tests conducted to assess preference, women compared pairs of brittle and elastic suppositories and indicated their preference. We observed an interaction, as women preferred brittle suppositories at lower G’ (250, 2500 Pa) and elastic ones at a higher G’ (25,000 Pa). In the second test, women evaluated samples across different G’, rated the ease-of-insertion and willingness-to-try and ranked the samples in order of preference. Brittle suppositories at G’ of 12,500 Pa were most preferred. In vitro studies were also conducted to measure the softening of the suppositories in contact with vaginal simulant fluid (VSF). Release of antiretroviral drug tenofovir in VSF was quantified for the brittle and elastic suppositories at G’ of 12,500 Pa to determine the effect of suppository type on release. The initial rate of release was 20% slower with elastic suppositories as compared to brittle suppositories. Understanding how different physical properties simultaneously affect women’s preferences and pharmacological efficacy in terms of drug release is required for the optimization of highly acceptable and efficacious microbicides.
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25
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Learning from the private sector: towards a keener understanding of the end-user for microbicide introduction planning. J Int AIDS Soc 2014; 17:19162. [PMID: 25224619 PMCID: PMC4163992 DOI: 10.7448/ias.17.3.19162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/24/2014] [Accepted: 07/22/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In planning for the introduction of vaginal microbicides and other new antiretroviral (ARV)-based prevention products for women, an in-depth understanding of potential end-users will be critically important to inform strategies to optimize uptake and long-term adherence. User-centred private sector companies have contributed to the successful launch of many different types of products, employing methods drawn from behavioural and social sciences to shape product designs, marketing messages and communication channels. Examples of how the private sector has adapted and applied these techniques to make decisions around product messaging and targeting may be instructive for adaptation to microbicide introduction. DISCUSSION In preparing to introduce a product, user-centred private sector companies employ diverse methods to understand the target population and their lifestyles, values and motivations. ReD Associates' observational research on user behaviours in the packaged food and diabetes fields illustrates how 'tag along' or 'shadowing' techniques can identify sources of non-adherence. Another open-ended method is self-documentation, and IDEO's mammography research utilized this to uncover user motivations that extended beyond health. Mapping the user journey is a quantitative approach for outlining critical decision-making stages, and Monitor Inclusive Markets applied this framework to identify toilet design opportunities for the rural poor. Through an iterative process, these various techniques can generate hypotheses on user drop-off points, quantify where drop-off is highest and prioritize areas of further research to uncover usage barriers. Although research constraints exist, these types of user-centred techniques have helped create effective messaging, product positioning and packaging of health products as well as family planning information. These methods can be applied to microbicide acceptability testing outside of clinical trials to design microbicide marketing that enhances product usage. CONCLUSIONS The introduction of microbicide products presents an ideal opportunity to draw on the insights from user-centred private sector companies' approaches, which can complement other methods that have been more commonly utilized in microbicide research to date. As microbicides move from clinical trials to real-world implementation, there will be more opportunities to combine a variety of approaches to understand end-users, which can lead to a more effective product launch and ultimately greater impact on preventing HIV infections.
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26
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Mahan ED, Zaveri T, Ziegler GR, Hayes JE. Relationships between perceptual attributes and rheology in over-the-counter vaginal products: a potential tool for microbicide development. PLoS One 2014; 9:e105614. [PMID: 25188244 PMCID: PMC4154878 DOI: 10.1371/journal.pone.0105614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 07/26/2014] [Indexed: 12/11/2022] Open
Abstract
Vaginal microbicides are believed to have substantial potential to empower women to protect themselves from HIV, although clinical trials to date have had mixed results at best. Issues with patient adherence in these trials suggest additional emphasis should be placed on optimizing acceptability. Acceptability is driven, in part, by the sensory properties of the microbicide, so better understanding of the relationships between sensory properties and the physical and rheological properties of microbicides should facilitate the simultaneous optimization of sensory properties in parallel with the biophysical properties required for drug deployment. Recently, we have applied standard methods to assess the potential acceptability of microbicide prototypes ex vivo and to quantify the sensory properties of microbicide surrogates. Here, we link quantitative perceptual data to the rheological properties of 6 over-the counter (OTC) vaginal products used as ex vivo microbicide surrogates. Shear-thinning behavior (n) and tan δ (10 rad/s) showed no relationship with any perceptual attributes while shear storage modulus, G’ (10 rad/s) was correlated with some attributes, but did not appear to be a strong predictor of sensory properties. Conversely, the storage loss modulus, G” (10 rad/s) and the consistency coefficient, K, were correlated with several sensory attributes: stickiness, rubberiness, and uniform thickness for G’’ and stickiness, rubberiness, and peaking for K. Although these relationships merit confirmation in later studies, this pilot study suggests rheological principles can be used to understand the sensory properties evoked by microbicide surrogates assessed ex vivo. Additional work is needed to determine if these findings would apply for microbicides in vivo.
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Affiliation(s)
- Ellen D. Mahan
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Toral Zaveri
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Gregory R. Ziegler
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - John E. Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- * E-mail:
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27
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van den Berg JJ, Rosen RK, Bregman DE, Thompson LA, Jensen KM, Kiser PF, Katz DF, Buckheit K, Buckheit RW, Morrow KM. "Set it and forget it": women's perceptions and opinions of long-acting topical vaginal gels. AIDS Behav 2014; 18:862-70. [PMID: 24248674 DOI: 10.1007/s10461-013-0652-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Women's initial understandings and anticipated acceptability of long-acting vaginal gels as potential anti-HIV microbicides was investigated by exploring the perceptibility variables associated with prototype formulations. Four focus groups with 29 women, aged 18-45, were conducted to consider gel prototypes with varied physicochemical and rheological properties. Participants responded favorably to the concept of long-acting vaginal gels as microbicides. Distinctions in understandings and stated needs regarding product dosing, characteristics, and effectiveness offer valuable insights into product design. Long-acting vaginal gels capable of protecting against HIV/STIs will be a viable option among potential users, with dosing frequency being an important factor in willingness to use.
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Affiliation(s)
- Jacob J van den Berg
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA,
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