U.S. Women Need the Dapivirine Ring, Too: FDA as Structural Barrier to HIV Prevention for Women

The dapivirine monthly vaginal ring-a discreet, anti-HIV microbicide created specifically for women-has received a positive scientific opinion by the European Medicines Agency and is included in the WHO HIV prevention guidelines. It has received regulatory approvals in several countries in southern and eastern Africa. During the review of the New Drug Application that was submitted in December 2020, FDA advised the developer, International Partnership for Microbicides, that it was unlikely to be approved in the United States; the application has since been withdrawn. This commentary will present the case for FDA approval for the dapivirine ring. Advocacy is urgently needed to protect U.S. women's access to user-controlled HIV prevention technologies, consistent with both global regulatory decisions to date and with a reproductive justice framework. Women continue to need the fullest range of HIV prevention methods to integrate into their lives in the most practical and effective way possible.

Efaverinz and nano-gold-loaded mannosylated niosomes: a host cell-targeted topical HIV-1 prophylaxis via thermogel system

Sexual dissemination of Human Immunodeficiency Virus-1 (HIV-1) is the prime mode of its spread. Topical microbicidal approach has gained much attention, but no real success is observed till date, either due to toxicity or resistance of active moieties and the lack of efficient drug delivery approaches. In this research protocol, a unique combination approach of a standard drug moiety, that is, Efaverinz (EFV) and a nanometal, that is, gold nanoparticles (GNPs) was tried. Both these candidates were delivered through a mannosylated niosomal system, to exploit protein (lectins present on HIV host cells) - carbohydrate (oligosaccharides such as mannan present on HIV gp-120 receptor) interaction. GNPs (10.4 nm average size) were entrapped inside the aqueous core, whereas lipophilic EFV was loaded in the bilayer membrane. Results demonstrated a significant increase in antiviral activity when EFV was fired with GNPs. Delivery of this combination via mannosylated niosomes proved to be a perfect approach with exceedingly well potential compared to non liganded niosomal system. A thermosensitive gel vehicle was prepared and the loaded niosomes were dispersed in it to have a nanogel system. The optimized formulation was evaluated for its prophylactic activity and the results showed completely inhibited viral dissemination at folds dilution levels.

Chemoprophylaxis for HIV prevention: new opportunities and new questions

Growing data suggest that antiretrovirals can be used as an effective means of HIV prevention. This article reviews the current status and future clinical prospects of utilizing antiretroviral chemoprophylaxis before and after high-risk HIV exposure to prevent HIV transmission. The discussion about using antiretrovirals as a means of primary HIV prevention has moved to the forefront of public health discourse because of a growing evidence base, the increased tolerability of the medications, the decreased cost, the ever-expanding formulary, and the limitations of other approaches.

Relationship context associated with microbicide-like product use

STUDY OBJECTIVE

Topical microbicides are being developed to provide an alternative method of prevention of HIV and sexually transmitted infections. Although topical microbicides would be a female-controlled method of prevention, their use is likely to be disclosed to partners. Thus, the characteristics of the partner relationship may play a role in their use. We sought to examine whether qualities of the relationship and of the partner were associated with using a microbicide-like product.

DESIGN

We studied 166 females (14 to 21 years of age) who were participating in a 6-month study of microbicide-like products (vaginal lubricants). They described partner relationships and characteristics of the partners.

RESULTS

Of the 166 participants, 118 used the product. In bivariate analyses, those whose relationships were longer, monogamous, more mutual, and more satisfying were more likely to use the product. Further, when sex occurred in the young women's or couples' homes, use also was more likely. There was no relationship between product use and whether the partner had a job or was in school or between the partners' levels of substance use. In a multivariable logistic regression with backwards elimination, only relationship satisfaction remained significant in the model.

CONCLUSION

Topical microbicides will be used within the context of a relationship, and characteristics of the relationship most likely will influence use. These findings suggest that special attention may have to be given to supporting use in high-risk relationships and that all interventions to enhance uptake should consider the relationship context.

Predictors of using a microbicide-like product among adolescent girls

PURPOSE

This study examined demographic, sexual history and weekly contextual variables, and perceptions about microbicides as predictors of microbicide-like product use.

METHODS

Adolescent girls (N = 208; 14-21 years) participated in a 6-month study in which they completed three face-to-face interviews and 24-weekly phone call interviews. Participants were given microbicide-like products (vaginal lubricants) and encouraged to use them with condoms when they had intercourse.

RESULTS

Of the girls, 75% had had a sexual opportunity to use the product. Using multi-variable logistic regression, the following variables independently predicted ever using the product: length of sexual experience, number of lifetime vaginal partners, and the Comparison to Condoms subscale on the Perceptions of Microbicides Scale. Using a mixed model repeated measure linear regression, the following variables independently predicted frequency of use: week of the study, age, condom frequency prior to the study, and three subscales on the Perceptions of Microbicide Scale: namely, the Comparison to Condoms subscale, the Negative Effects subscale, and the Pleasure subscale.

CONCLUSION

Most girls used the product, including those who were not protecting themselves with condoms. Girls' initial perceptions regarding the product predicted initial use and frequency of use. Further research should evaluate the best methods for supporting the use of these products by young or sexually less experienced girls.

Adolescent girls' communication with "mothers" about topical microbicides

STUDY OBJECTIVE

Topical microbicides, a female-initiated method to protect against sexually transmitted infections (STI) and pregnancy, will only be effective if found acceptable. Mothers may have an influence on acceptability and use among adolescent girls. The current study examined the communication between girls and mothers to understand the potential predictors and nature of conversations regarding surrogate microbicide products.

DESIGN

Sexually experienced girls, 14 to 21 years, were recruited for a 6-month study examining microbicide acceptability. During face-to-face interviews, qualitative data were collected regarding communication between girls and mothers. Two independent raters coded the responses, which were organized into themes. Themes were interpreted according to the conceptual understanding of mother-daughter communication.

RESULTS

Fifty percent of the 171 girls with codable responses had a conversation with their mother. Higher levels of indirect parental monitoring were related to being more likely to have a conversation. Concrete events related to the study (i.e. receiving phone call from the researcher, having an appointment, or seeing the product) or inquiries by mothers appeared to promote conversation. Barriers to conversation included the private nature of the information and relationship issues between the mother and daughter. Conversations often addressed issues related to girls' participation in the study, although some conversations included global issues related to sexuality.

CONCLUSIONS

Girls may talk to their mothers about new products for STI prevention, and such conversations may provide opportunities to promote use.