Multipurpose prevention technologies: the future of HIV and STI protection

Abstract

Every day, more than 1 million people are newly infected with sexually transmitted infections (STIs) that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition. Existing prevention and management strategies, including behavior change, condom promotion, and therapy have not reduced the global incidence and prevalence, pointing to the need for novel innovative strategies. This review summarizes important issues raised during a satellite session at the first HIV Research for Prevention (R4P) conference, held in Cape Town, on October 31, 2014. We explore key STIs that are challenging public health today, new biomedical prevention approaches including multipurpose prevention technologies (MPTs), and the scientific and regulatory hurdles that must be overcome to make combination prevention tools a reality.

Keywords: HIV; HPV; HSV-2; STI; Trichomonas vaginalis; multipurpose prevention technologies.

Copyright © 2015 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Global total incidence of selected curable STIs

The figure shows the incidence of four curable STIs (T. vaginalis, T. pallidum, N. gonorrhoeae and C. trachomatis) in the six global regions in 2008. The global estimates, especially for these curable STIs, have relied on the few regions with systematic STI surveillance along with a relatively small number of prevalence studies among discrete populations. The World Health Organization (WHO) estimates do not include viral STIs, which are often longstanding or lifelong, and comprise a large proportion of prevalent STIs. Modified from WHO STIs Fact sheet #110 [http://www.who.int/mediacentre/factsheets/fs110/en/].

Figure 2. MPT delivery devices

(A) Male and female condom. (B) Vaginal/rectal gels. (C) Implants. (D) Injectables. (E) Intravaginal rings. (F) Nanofibers (photograph is courtesy of A. Steger and K.A. Woodrow, University of Washington). (G) SILCS diaphragm (photograph is courtesy of PATH. All rights reserved). (H) Vaginal tablet (photograph is courtesy of M. Clark and D. Friend, CONRAD). Images A, B, D, E by Julie Sitney (Population Council).