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Vora LK, Tekko IA, Volpe Zanutto F, Sabri A, Choy RKM, Mistilis J, Kwarteng P, Kilbourne-Brook M, Jarrahian C, McCarthy HO, Donnelly RF. Development of Norelgestromin Dissolving Bilayer Microarray Patches for Sustained Release of Hormonal Contraceptive. Pharmaceutics 2024; 16:946. [PMID: 39065643 PMCID: PMC11279563 DOI: 10.3390/pharmaceutics16070946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Microarray patches (MAPs) offer a noninvasive and patient-friendly drug delivery method, suitable for self-administration, which is especially promising for low- and middle-income country settings. This study focuses on the development of dissolving bilayer MAPs loaded with norelgestromin (NGMN) as a first step towards developing a future potential drug delivery system for sustained hormonal contraception. The fabricated MAPs were designed with the appropriate needle lengths to penetrate the stratum corneum, while remaining minimally stimulating to dermal nociceptors. Ex vivo assessments showed that the MAPs delivered an average of 176 ± 60.9 μg of NGMN per MAP into excised neonatal porcine skin, representing 15.3 ± 5.3% of the loaded drug. In vivo pharmacokinetic analysis in Sprague Dawley rats demonstrated a Tmax of 4 h and a Cmax of 67.4 ± 20.1 ng/mL for the MAP-treated group, compared to a Tmax of 1 h and a Cmax of 700 ± 138 ng/mL for the intramuscular (IM) injection group, with a relative bioavailability of approximately 10% for the MAPs. The MAP-treated rats maintained plasma levels sufficient for therapeutic effects for up to 7 days after a single application. These results indicate the potential of NGMN-loaded dissolving bilayer MAPs, with further development focused on extending the release duration and improving bioavailability for prolonged contraceptive effects.
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Affiliation(s)
- Lalitkumar K. Vora
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (L.K.V.)
| | - Ismaiel A. Tekko
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (L.K.V.)
| | - Fabiana Volpe Zanutto
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (L.K.V.)
| | - Akmal Sabri
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (L.K.V.)
| | | | | | | | | | | | - Helen O. McCarthy
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (L.K.V.)
| | - Ryan F. Donnelly
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (L.K.V.)
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Harrington EK, Hauber B, Ouma DC, Kimanthi S, Dollah A, Onono M, Bukusi EA. Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1360390. [PMID: 38774834 PMCID: PMC11107089 DOI: 10.3389/frph.2024.1360390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Despite increasing global commitment to meeting the family planning needs of adolescent girls and young women (AGYW), there is limited research on how they prioritize contraceptive method and service delivery characteristics. In this qualitative study, we examine the specific elements that drive the contraceptive choices of Kenyan AGYW, and apply our findings to the development of attributes and levels for a discrete choice experiment (DCE). Methods Our four-stage approach included data collection, data reduction, removing inappropriate attributes, and optimizing wording. Between June-October 2021, we conducted in-depth interviews with 30 sexually-active 15-24 year-old AGYW in Kisumu county, Kenya who were non-pregnant and desired to delay pregnancy. Interviews focused on priorities for contraceptive attributes, how AGYW make trade-offs between among these attributes, and the influences of preferences on contraceptive choice. Translated transcripts were qualitatively coded and analyzed with a constant comparative approach to identify key concepts. We developed and iteratively revised a list of attributes and levels, and pre-tested draft DCE choice tasks using cognitive interviews with an additional 15 AGYW to optimize comprehension and relevance. Results In-depth interview participants' median age was 18, 70% were current students, and 93% had a primary sexual partner. AGYW named a variety of priorities and preferences related to choosing and accessing contraceptive methods, which we distilled into six key themes: side effects; effectiveness; user control; privacy; source of services; and cost. Bleeding pattern was top of mind for participants; amenorrhea was generally considered an intolerable side effect. Many participants felt more strongly about privacy than effectiveness, though some prioritized duration of use and minimizing chance of pregnancy above other contraceptive characteristics. Most AGYW preferred a clinic setting for access, as they desired contraceptive counseling from a provider, but pharmacies were considered preferable for reasons of privacy. We selected, refined, and pre-tested 7 DCE attributes, each with 2-4 levels. Conclusions Identifying AGYW preferences for contraceptive method and service delivery characteristics is essential to developing innovative strategies to meet their unique SRH needs. DCE methods may provide valuable quantitative perspectives to guide and tailor contraceptive counseling and service delivery interventions for AGYW who want to use contraception.
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Affiliation(s)
- Elizabeth K. Harrington
- Department of OB/GYN, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Brett Hauber
- School of Pharmacy, Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
- Pfizer, Inc., New York, NY, United States
| | - Dismas Congo Ouma
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Syovata Kimanthi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A. Bukusi
- Department of OB/GYN, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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El-Sahn M, Elliott R, El-Sahn M, Lucas J, Wood Santos T. End-user research into understanding perceptions of and reactions to a microarray patch (MAP) for contraception among women in Ghana, Kenya and Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1351692. [PMID: 38515793 PMCID: PMC10954799 DOI: 10.3389/frph.2024.1351692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Many organizations are developing new contraceptive products and approaches that promote self-care including a microarray patch (MAP) that has the potential for self-administration with appropriate training. We studied women's perceptions of the MAP technology with the primary goal of providing feedback on product attributes to inform early technical design decisions regarding various MAP contraceptive products in development by MAP developers. Methods Our study consisted of a qualitative phase with in-person In-Depth Interviews (IDIs) with a total of 60 women of reproductive age (WRA) and quantitative surveys, via face-to-face computer-assisted interviews of a total of 927 women in Ghana, Kenya and Uganda. Women's perceptions on 12 attributes of the MAP were assessed through written descriptions, a profile, and visual stimuli such as graphics and images. Results Overall, the most widely preferred attribute set included: a hand-applied MAP, utilizing one circular patch, with a sticky backing, no larger than 2 cm diameter in size, applied by self, to the arm, offering sensory feedback (clicking sound and/or color change signals) to confirm enough pressure, successful application and removal, lasting 6 months with up to 12 months return to natural state of fertility. There is space to allow for variation in MAP designs (including the use of an applicator or provider administered MAP) if the design promotes and reflects the needs and expectations of users and providers. Discussion The contraceptive MAP had a high and broad level of appeal amongst all groups of women who participated in the study and has a strong value proposition around important contraceptive needs such as ease of use, convenience, and discretion.
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Brunie A, Callahan R. Understanding how they really feel: Lesson learned from four approaches to soliciting user preferences for new contraceptive products in development. Gates Open Res 2024; 7:81. [PMID: 38449538 PMCID: PMC10914729 DOI: 10.12688/gatesopenres.14679.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/08/2024] Open
Abstract
Background An expanded range of contraceptive methods could reduce unintended pregnancies. User preferences research is important for successful development of products people want to use. This paper describes four approaches to preferences research soliciting user input in different ways: 1) perspectives on contraceptive method characteristics, 2) reactions to products in development, 3) trade-offs between contraceptive method characteristics, and 4) "blue-sky" ideas on novel contraceptive technologies. Methods We conducted two mixed-method studies: one implemented in Burkina Faso and Uganda combining three of these approaches, and the other implemented in India and Nigeria using two approaches. We share observations on the strengths and weaknesses of each approach and draw on our experience to highlight lessons learned for future user preferences studies. Results Each approach contributes to product development in different ways, and the usefulness of each methodology depends on the product development stage and corresponding informational needs. Conclusions Recommendations for future research include combining different methods, angles, and perspectives; using sequential designs whenever possible; tailoring product descriptions to user understanding for optimal feedback; and acknowledging the value and limitations of both quantitative results for modeling demand and idiosyncratic ideas to inspire development of new products.
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Affiliation(s)
- Aurélie Brunie
- Health Services Research, FHI 360, Washington, District of Columbia, USA
| | - Rebecca Callahan
- Product Development and Introduction, FHI 360, Durham, North Carolina, USA
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Ismail A, Magni S, Katahoire A, Ayebare F, Siu G, Semitala F, Kyambadde P, Friedland B, Jarrahian C, Kilbourne-Brook M. Exploring user and stakeholder perspectives from South Africa and Uganda to refine microarray patch development for HIV PrEP delivery and as a multipurpose prevention technology. PLoS One 2023; 18:e0290568. [PMID: 37651432 PMCID: PMC10470907 DOI: 10.1371/journal.pone.0290568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, but alternative delivery options are needed to reach more users. Microarray patches (MAPs), a novel drug-delivery system containing micron-scale projections or "microneedles" that deliver drugs via skin, are being developed to deliver long-acting HIV PrEP and as a multipurpose prevention technology to protect from HIV and unintended pregnancy. We explored whether MAP technology could meet user and health system needs in two African countries. METHODS Researchers in South Africa and Uganda conducted 27 focus group discussions, 76 mock-use exercises, and 31 key informant interviews to explore perceptions about MAPs and specific features such as MAP size, duration of protection, delivery indicator, and health system fit. Participants included young women and men from key populations and vulnerable groups at high risk of HIV and/or unintended pregnancy, including adolescent girls and young women; female sex workers and men who have sex with these women; and men who have sex with men. In Uganda, researchers also recruited young women and men from universities and the community as vulnerable groups. Key stakeholders included health care providers, sexual and reproductive health experts, policymakers, and youth activists. Qualitative data were transcribed, translated, coded, and analyzed to explore perspectives and preferences about MAPs. Survey responses after mock-use in Uganda were tabulated to assess satisfaction with MAP features and highlight areas for additional refinement. RESULTS All groups expressed interest in MAP technology, reporting perceived advantages over other methods. Most participants preferred the smallest MAP size for ease of use and discreetness. Some would accept a larger MAP if it provided longer protection. Most preferred a protection duration of 1 to 3 months or longer; others preferred 1-week protection. Upper arm and thigh were the most preferred application sites. Up to 30 minutes of wear time was considered acceptable; some wanted longer to ensure the drug was fully delivered. Self-administration was valued by all groups; most preferred initial training by a provider. CONCLUSIONS Potential users and stakeholders showed strong interest in/acceptance of MAP technology, and their feedback identified key improvements for MAP design. If a MAP containing a high-potency antiretroviral or a MAP containing both an antiretroviral and hormonal contraceptive is developed, these products could improve acceptability/uptake of protection options in sub-Saharan Africa.
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Affiliation(s)
| | - Sarah Magni
- Genesis Analytics, Johannesburg, South Africa
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Florence Ayebare
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Godfrey Siu
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | | | - Peter Kyambadde
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Maytan-Joneydi A, MacLachlan EW, Agali BI, Louis-Charles K, Chaibou S, Amadou Garba S, Moumouni AN, Speizer IS. Providers' views on hormonal family planning methods: a qualitative study from Dosso, Niger. Gates Open Res 2022; 6:75. [PMID: 36262978 PMCID: PMC9550940 DOI: 10.12688/gatesopenres.13674.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Family planning (FP) providers play an important role in ensuring that clients are offered a full range of FP methods. This qualitative study explores providers' views on three hormonal FP methods and why they think women may choose these methods in Niger. Methods: In-depth interviews were conducted with 24 FP providers in 24 government health centers in Dosso region, Niger between February-March 2020. Providers were asked about the suitability of different FP methods for women, including adolescents and married women with children. The interviews were translated and transcribed from Hausa and Zarma into French, thematically coded, and qualitatively analyzed. Results: Many providers believed discretion to be the most important method attribute for women. Providers report preferring implants for young clients because of the more rapid return to fertility. They disagreed on whether implants or injectables are more discrete for clients. That said, providers felt that clients appreciate the implant's discretion, effectiveness, long-acting nature, and simplicity of use. Providers perceived that the majority of women choose injectables due to familiarity with the method, the fact that it is "invisible" to an outsider, and a lack of awareness of implants. Providers stated that while women may not initially choose the implant, when given more information about it, they were more open to adopting it, or switching from another method, and less likely to believe local myths. Providers believed that women find pills to be indiscreet. Conclusions: The findings highlight that while providers have perspectives on suitable methods for certain women, they also recognize that clients have their own preferences, such as how discreet the method is. As programs continue to expand method choice and new contraceptive technologies undergo research and development, highly desirable features such as discretion need to be considered.
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Affiliation(s)
- Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | | | | | - Kyria Louis-Charles
- Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA
| | | | | | | | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA,Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA,
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Maytan-Joneydi A, MacLachlan EW, Agali BI, Louis-Charles K, Chaibou S, Amadou Garba S, Moumouni AN, Speizer IS. Providers' views on hormonal family planning methods for young women: a qualitative study from Dosso, Niger. Gates Open Res 2022; 6:75. [PMID: 36262978 PMCID: PMC9550940 DOI: 10.12688/gatesopenres.13674.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Family planning (FP) providers play an important role in ensuring that clients are offered a full range of FP methods. This qualitative study explores providers' views on three hormonal FP methods and why they think young women may choose these methods in Niger. Methods: In-depth interviews were conducted with 24 FP providers in 24 government health centers in Dosso region, Niger between February-March 2020. Providers were asked about the suitability of different FP methods for women, including unmarried adolescents and young married women with children. The interviews were translated and transcribed from Hausa and Zarma into French, thematically coded, and qualitatively analyzed. Results: Many providers believed discretion to be the most important method attribute for women. Providers report preferring implants for young clients because of the more rapid return to fertility. They disagreed on whether implants or injectables are more discrete for clients. That said, providers felt that clients appreciate the implant's discretion, effectiveness, long-acting nature, and ease of use. Providers perceived that the majority of women choose injectables due to familiarity with the method, the fact that it is "invisible" to an outsider, and a lack of awareness of implants. Providers stated that while women may not initially choose the implant, when given more information about it, they were more open to adopting it, or switching from another method, and less likely to believe local myths. Providers believed that women find pills to be indiscreet. Conclusions: The findings highlight that while providers have perspectives on suitable methods for certain women, they also recognize that clients have their own preferences, such as how discreet the method is. As programs continue to expand method choice and new contraceptive technologies undergo research and development, highly desirable features such as discretion need to be considered.
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Affiliation(s)
- Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | | | | | - Kyria Louis-Charles
- Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA
| | | | | | | | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA,Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, NC, 27516, USA,
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Li W, Chen JY, Terry RN, Tang J, Romanyuk A, Schwendeman SP, Prausnitz MR. Core-shell microneedle patch for six-month controlled-release contraceptive delivery. J Control Release 2022; 347:489-499. [PMID: 35550913 DOI: 10.1016/j.jconrel.2022.04.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
There is a tremendous need for simple-to-administer, long-acting contraception, which can increase access to improved family planning. Microneedle (MN) patches enable simple self-administration and have previously been formulated for 1-2 months' controlled release of contraceptive hormone using monolithic polymer/drug MN designs having first-order release kinetics. To achieve zero-order release, we developed a novel core-shell MN patch where the shell acts as a rate-controlling membrane to delay release of a contraceptive hormone, levonorgestrel (LNG), for 6 months. In this approach, LNG was encapsulated in a poly(lactide-co-glycolide) (PLGA) core surrounded by a poly(l-lactide) (PLLA) shell and a poly(D,l-lactide) (PLA) cap that were fabricated by sequential casting into a MN mold. Upon application to skin, the core-shell MNs utilized an effervescent interface to separate from the patch backing within 1 min. The core-shell design limited the initial 24 h burst release of LNG to 5.8 ± 0.5% and achieved roughly zero-order LNG release for 6.2 ± 0.1 months in vitro. A monolithic MN patch formulated with the same LNG and PLGA core, but without the rate-controlling PLLA shell and PLA cap had a larger LNG burst release of 22.6 ± 2.0% and achieved LNG release for just 2.1 ± 0.2 months. This study provides the first core-shell MN patch for controlled months-long drug release and supports the development of long-acting contraception using a simple-to-administer, twice-per-year MN patch.
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Affiliation(s)
- Wei Li
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, Hubei 430071, China.
| | - Jonathan Yuxuan Chen
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Richard N Terry
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Jie Tang
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrey Romanyuk
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Steven P Schwendeman
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark R Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
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Sims LB, Appenroth MN. Contraceptive technology research & development: a call for inclusion of trans and gender diverse individuals assigned female at birth. EUR J CONTRACEP REPR 2021; 27:142-147. [PMID: 34845964 DOI: 10.1080/13625187.2021.2000960] [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: 10/19/2022]
Abstract
OBJECTIVE Increased research efforts over the past decade provide a more in-depth understanding of the diverse fertility desires and family planning needs of trans and gender diverse individuals assigned female at birth (TGD AFAB). Despite this increased understanding and unmet need, global health researchers and contraceptive product developers have yet to include TGD AFAB individuals and considerations of their needs in the product development process, marginalising this historically underrepresented population. The aim of this perspective is to present the case for inclusion of TGD AFAB individuals in contraceptive research. MAIN OUTCOMES This perspective summarises the most recent literature characterising contraceptive access and use within TGD AFAB populations as well as the barriers to use. Furthermore, this perspective offers insight into how novel contraceptive technologies in the research and development pipeline could potentially appeal to TGD AFAB populations and recommends steps product developers can make towards being more inclusive. CONCLUSIONS With current research efforts in contraceptive product development aimed at expanding the method mix to appeal to a more diverse population of potential users, it behoves product developers to be more inclusive of TGD AFAB individuals in the development process and consider them as stakeholders of an expanded contraceptive method mix.
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Affiliation(s)
- Lee B Sims
- United States Agency for International Development, Global Health Technical Professionals Program, Public Health Institute
| | - Max N Appenroth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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