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Advances in Barrier Methods & the Future of Multipurpose Prevention

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Advances in Barrier Methods & the Future of Multipurpose Prevention Advances in Barrier Methods & the Future of Multipurpose Prevention Technologies (MPTs) Anke Hemmerling MD, PhD, MPH Universities of California, San Francisco & Berkeley Initiative for MPTs (IMPT) National Reproductive Health Conference, July 24-27, 2016; Chicago, IL Disclosures Anke Hemmerling, MD, PhD, MPH Commercial Interest Role Status Nothing to disclose Objectives By the end of this session participants will be able to: . Define Multipurpose Prevention Technologies (MPTs). Identify an important attribute of a diverse product development pipeline for women’s reproductive health needs that encompass contraception as well as STI protection . Analyze at least one complexity in developing new products that combine multiple indications and active pharmaceutical ingredients into singular products Sexual & Reproductive Health Risks are Interlinked Unintended Pregnancy HIV Women need better Other Sexually Transmitted protection Infections (STIs) HIV, HSV-2, HPV, & Unmet Need for Modern Contraception among Women Source: Schelar, et al. http://www.contraceptionjournal.org/article/S0010-7824%2815%2900577-6/ Multipurpose Prevention Technologies (MPTs) MPTs combine protection against: . Unintended pregnancy . HIV . Other STIs A Suite of Products is Needed Contraception + HIV & Contraception + Contraception + HIV + STI STI Prevention HIV Prevention STI Prevention Prevention Initiative for MPTs (IMPT) Expansion of Focus Science & Technical Aspects of MPT Development Social-behavioral & Market Access Scientific Feasibility Delivery & Distribution Product Prioritization & Market Access Gap Analysis Framework Dosage Form Specific Market Research TPPs Impact Modeling MPT Pipeline Database Communications and Advocacy among key stakeholder groups Barrier Methods Male and female condoms are the only currently available methods for prevention of multiple SRH risks . Diaphragms . Cervical Caps . Other Cervical Barriers . Female Condoms . Male Condoms (sole source) Your Mother’s Diaphragm PROS CONS . Effective if consistently correctly . Requires Anticipatory motivation used . Correct use during coitus . Perfect-use pregnancy rate 6% . 6 hrs before & 6 hrs after . Limited STI reduction potential . + spermicide . Reusable . Typical-use pregnancy rate 12% . Requires MD to fit . Before 2014: 2 U.S. diaphragms . Milex Wide-Seal Arcing Style . Omniflex Diaphragm SILCS Diaphragm - Caya® . Developed by PATH . with support of CONRAD + USAID . Marketed in Europe as Caya® (sole source) by Kessel, Germany . FDA approved September 2014 . Single size reusable, covers cervix . Flexible rim with room for drug load . Silicone membrane, 2 cups . Larger cup fits loosely over cervix . Smaller cup aids as hooking rim for removal . No provider or fit training SILCS (Caya®) (sole source) as MPT . Flexible rim with room for drug load can serve as reusable delivery system for a ARV microbicide gel + Overview Additional Barriers Protectaid® Shanghai Lily Pirri Pharma, Canada (sole SL Life Rubber Product Co., Ltd, source) polyurethane foam China (sole source) sponge impregnated with F- Latex 5 Gel (N9, BKC, NACOL) 4 sizes: 54, 58, 62, 66mm Canada & Europe Semina Diaphragm FemCap Semina Industries, FemCap, Inc. (sole source) Commerce Ltd. Brazil (sole silicone cap, removal strap, source) brim holds spermicide/trap Silicone diaphragm, coil sperm spring, 60-85mm (5mm 3 sizes: 22, 26, 30mm increments) In U.S. & Europe Duet™ (sole source) single size 3 layers of protection vaginal-side gel, barrier film, cervical-side gel Courtesy of Michelle Forcier OOvverviewerviewofFemale Female Condoms Condoms Cupid Material: natural latex, poly- urethane foam Female internal retainer Condom Available in: India, Brazil, Indonesia, South (sole source) Africa, Mozambique Cupid Limited India Female Material: nitrile polymer, inner ring for easier Condom insertion and positioning, softer outer ring FC2 Available in: U.S. and 100 countries (sole source) Female Health Company Phoe Material: polyurethane, plus insertion tool, Nurse water-based lubricant Available in: China, Brazil (sole source) Tianjin Kangdunbao Co. China http://www.cervicalbarriers.org/products/ OvOerviewverviewof FemaleFemale Condoms Condoms Panty Material: polyethylene w lube, re-usable panty Condom holds condom in place, Available in: Colombia (sole source) Innova Quality S.A.S., Colombia Material: nitrile polymer molded with anatomy- Origami specific design, inserted before intercourse Internal Available in: late 2016 in US, EU Condom Origami Healthcare Products Inc., Strata Various Product Design (sole source) Woman's Material: polyurethane, dissolving capsule for Condom insertion, foam for stability, water based (sole source) lubricant Available in: China (as O'Lavie) PATH, Shanghai Dahua Medical Apparatus Company Ltd., China http://www.cervicalbarriers.org/products/ Upcoming Trends in Condoms S.T.EYE Condom (sole source) glows green, detects bacteria/STIs green=chlamydia, yellow=herpes, purple=HPV, blue=syphilis by TeenTech awards students at Isaac Newton Academy in Illford http://www.cnet.com/news/color-changing-condom-shows- presence-of-stds/ Skyn Condom (sole source) thin polyisoprene, self lubricating, skin-to-skin sensation, biodegradable http://us.skyncondoms.com/ Hydrogel Condom (sole source) ultra-strong, skin-like prosthetics tissue makers Australia's University of Wollongong, Project Geldom improved naturalistic feel, building in automatically released internal lube or Viagra http://www.dazeddigital.com/artsandculture/article/24406/1/ch eck-out-the-worlds-most-futuristic-condom Courtesy of Michelle Forcier MPTs: Many Possibilities Indications Pregnancy, HSV, HPV, HIV, BV, Chlamydia, Gonorrhea, Syphilis, Candida, Trichomonas Product Types Delivery Methods Vaginal film, Vaginal tablet, Oral MPT Product Topical daily, Topical pericoital, tablet, Vaginal ring, Non-IVR Possibilities Systemic sustained, Topical device, Vaginal gel, Injectable, sustained, Oral daily, Oral Implantable pericoital Active Pharmaceutical Ingredients HC, Non-HC, Barrier, Probiotic, Antimicrobial, Antifungal, Antiviral Preclinical Studies Clinical Studies (Critical Path) Pre-IND IND NDA Discovery Phase II Phase III Phase IV Preclinical Phase I Candidate Expanded Safety & Additional Virology Initial Safety Identification Safety Efficacy Monitoring Animal Safety Toxicology & Pharmacology In vitro & Post Ex vivo Licensure Testing Acute Chronic Reproductive Carcinogenesis Marketing Preformulation Formulation Vehicle optimization (delivery) Chemistry, Manufacturing Commercial & Control (CMC) Scale-up Supply Behavioral & Social Sciences Perceptibility: Individual preferences Initial Expanded Acceptability for Physical & Rheological Properties: Acceptability target population Marketing Research Identification of Confirmation population specific Creating Perceptibility issues population specific approaches Development of use instructions Healthcare Service Service Healthcare Critical Delivery Elements for inclusion in pipeline Contraceptives Bench (HC & non-HC) Science MPT Pipeline ARVs & non-ARVs Inputs Delivery Platforms Etc. Stages of Development Discovery Preclinical Clinical Pipeline MPTs: a promising response to current challenges around hormonal contraceptive methods and HIV 2016 International Conference on Family Planning – 27 January 2016 – Nusa Dua, Indonesia Options for MPTs Co-formulated: Multiple API formulated into a single dose Co-administered: Two separate products used together Co-packaged: Two different doses packaged together into single product for simultaneous co-use MPT Concept: Oral Truvada® (sole source)+ Oral Contraceptives MPTs in the Development Pipeline . Long acting vaginal rings . Fast dissolving films and tablets . Innovative gels . Injectables . Nanofiber delivery systems . Biotherapeutics Priorities for 1st Generation MPTs On demand Sustained release • Used at time of intercourse • Vaginal ring or long-acting • For intermittent sex injectable • Oral or topical • No daily administration required • Potential for increases adherence and effectiveness Sustained Release Devices: MPT IVRs 90-day Dapivirine (sole source) 90-day TFV + LNG + LNG (IPM) (CONRAD) (sole source) • Silicone matrix ring • Segmented PU ring • Advanced pre-clinical stages • Phase I clinical study • Pregnancy, HIV • Pregnancy, HIV, HSV-2 MPTs in development: Gels and Films HIV + Other STIs 1.0% Tenofovir Vaginal Gel Phase III HIV, HSV mapp66 (mAb) Vaginal Film Phase I HIV, HSV MIV-150 + Zinc acetate + Phase I HIV, HSV, HPV Carrageenan Vaginal Gel Tenofovir Vaginal Film, Tablet Phase I HIV, HSV TFV/FTC Vaginal Tablet Phase I HIV, HSV VivaGel Phase I HIV, HSV, BV SILCS Diaphragm + MIV-150 + Zinc Advanced HIV, HSV, HPV, acetate + Carrageenan Vag Gel Pre-clinical Pregnancy Griffithsin vaginal insert/gel Early Pre-clinical HIV, HSV, HPV Pregnancy, HIV & Other STIs Amphora gel Phase I BV, Gon, Pregnancy HIV, HSV, HPV, Chl, PPMC SAMMA gel Pre-clinical Gon, Pregnancy MPTs in development: Intravaginal Rings HIV + Pregnancy & Other STIs Tenofovir + Levonorgestrel IVR Phase I HIV, HSV, Pregnancy Dapivirine + Levonorgestrel IVR Advanced Preclinical HIV, Pregnancy HIV & Other STIs Tenofovir + Acyclovir IVR Phase I HIV, HSV Tenofovir Disoproxil Fumerate HIV, HSV Phase I (TDF) IVR Tenofovir + IQP-0528 IVR Advanced Preclinical HIV, HSV Griffithsin IVR Early Preclinical HIV, HSV, HPV Uniting researchers and developers in contraception & HIV prevention . Unite experts in contraception and MPT development to discuss MPT research . Review gaps and challenges, identify
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