The Sunday News
Robin Muchetu, Senior Reporter
THE use of implants with multiple purposes in HIV prevention and treatment are set to change the face of management of the disease as these advanced methods are likely to be embraced more in the future.
With young women in Zimbabwe being noted as one of the groups that are most at risk, the new Multi Purpose Technologies (MTP) will see women being able to use a single device for HIV prevention, Sexually Transmitted Infections treatment and family planning.
According to Angelo Kaggwa Katumba Programme Manager from AVAC a New York City-based international non-profit community- and consumer-based organisation working to accelerate ethical development and delivery of Aids vaccines and other HIV prevention options, the future of non vaccine HIV prevention products include oral pills, vaginal rings, vaginal and rectile gels, vaginal films, long acting injectible ARVs and more.
“There are also a range of multipurpose prevention technologies in development that aim to reduce the risk of HIV for women and also provide contraception for them. Which means that a woman can access ARVs, STI treatment and contraceptives in one device that will be inserted in their body,” he said.
The use of a single device, he said makes the process of seeking health services for women more pleasurable as they will be getting their various medical needs in one go unlike seeking three or more services at different service providers.
Mr Kaggwa-Katumba said there was need to support HIV prevention mechanisms.
“If we do not create a demand for prevention interventions then there will be no effect in the work we are trying to do.
“Like now PrEP is struggling to take off in some areas. It is still a limitation to some people and drinking the tablets orally is also a challenge, so technologies of having injectibles is the future,” he said.
Future interventions include an intravaginal ring that stays in for 90 days and releases two hormones, Levonogestrel for contraception and Tenofovir for HIV prevention.
Another is also an intravaginal ring that also stays in for 90 days and releases a combination of Daprivirine to prevent HIV and Levonogestrel releasing hormone to prevent pregnancy too.
The Daprivirine injected ring could enter the market by 2020 as it is still under trial in Zimbabwe and other countries.
The multipurpose products can then follow after the ring is released. It is also projected that the earliest injectible HIV prevention drugs could be on the market in 2022.
AVAC also postulates that the HIV prevention implant will be available as soon as 2025 which will include multiple devices in the body and two active drugs.
Dr Nyaradzo Mgodi a Histopathologist who conducts HIV clinical trials in women of reproductive age in Harare at the University of Zimbabwe-University of California San Francisco (UZ-UCSF) Collaborative Research Programme said young women need to be broadly integrated in HIV programmes.
“In Zimbabwe we have 250 new infections each week in young women. The magnitude is worrying and preventing five or even three new infections is a lot.
“There is a deliberate move to target women as they are the hardest hit population in terms of infection, but we have not forgotten the other populations too,” he said.
She said the use of HIV prevention tools such as PrEP is useful in averting new infections in young women.
“Despite the availability of various methods of preventing HIV such as condoms, PrEP, Voluntary Medical Male Circumcision we still have an increase in new infections.
“Oral PrEP is a truly beautiful product that is available before you are exposed. We know that one point you may be exposed to HIV as a sexually active person but oral PrEP can protect you from infection,” she said.
Dr Mgodi said Truvada (oral PrEP) is available and it works well if taken correctly and consistently and protection goes beyond 90 percent and even 99 percent if used as prescribed.
However, she said if a dose is missed in women, then protection comes down which is risky.
“If a man takes four doses per week of the prescribed intake, they are still protected when taking oral PrEP but that is not the same with women whose health becomes severely compromised if they miss a dose.
“Women who skip doses are at high risk as the drug is less forgiving in women than men because of the route that the infection comes in.
“The rectum, in the case of men who have sex with men, while women it is via the vagina, the drug Tenofovir which is used in oral PrEP, varies in concentration in both the anus and vagina,” she said.
The vagina shows that inflammation or infection breaks down Tenofovir based products, and it will not be very effective unlike men in the rectum or women who have sex via the rectum.
Studies, however, are being done to try and find a solution to change this.
The vaginal ring is under study at the moment to see its effectiveness in HIV prevention in women. It is infused with an antiretroviral called Daprivirine which slowly releases the drugs over a period of 30 days but work is already being done for a 90-day option.
The eventual cost of the vaginal ring is yet to be determined but researchers want it to be cost effective so that all women can access it and prevent HIV infection.
“Preliminary studies show that over 80 percent of the women who were given the vaginal ring used it and adherence was high.
“The HIV reduction rate stood at 30 percent in general but went up to as much as 80 percent. It has a 54 percent HIV reduction rate in the interim results being shown,” added Dr Mgodi.
