Equipping providers to offer novel MPTs: Developing counseling messages for the Dual Prevention Pill in clinical studies and beyond

Frontiers in Reproductive Health

Reproductive Health

Kate Segal¹  Danielle M. Harris²  Andy Carmone³  Chris Jones⁴  Lisa B. Haddad⁵  Karin Hatzold⁶  Eva Lathrop⁶  Jennifer Mason⁷  Meridith Mikulich⁷  Sanjay Hadigal⁸ 

[1] AVAC, New York, NY, United States;Catalyst Global, Carlsbad, CA, United States;Clinton Health Access Initiative (CHAI), Boston, MA, United States;Mann Global Health, Columbus, NC, United States;Population Council, Center for Biomedical Research, New York, NY, United States;Population Services International (PSI), Washington, DC, United States;United States Agency for International Development (USAID), Office of Population and Reproductive Health, Bureau of Global Health, Washington, DC, United States;Viatris, Department of Global Medical Affairs, Pittsburgh, PA, United States;

关键词: pre-exposure prophlyaxis;    oral contraception;    HIV prevention;    family planning;    sexual and reproductive health;    multi-purpose prevention technologies;    service delivery;    provider counseling;   

DOI  :  10.3389/frph.2023.1155948

 received in 2023-02-01, accepted in 2023-04-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThe pipeline for multi-purpose prevention technologies includes products that simultaneously prevent HIV, pregnancy and/or other sexually transmitted infections. Among these, the Dual Prevention Pill (DPP) is a daily pill co-formulating oral pre-exposure prophylaxis (PrEP), and combined oral contraception (COC). Clinical cross-over acceptability studies for the DPP require training providers to counsel on a combined product. From February 2021–April 2022, a working group of eight HIV and FP experts with clinical and implementation expertise developed counseling recommendations for the DPP based on existing PrEP/COC guidance.Assessment of policy/guidelines options and implicationsThe working group conducted a mapping of counseling messages from COC and oral PrEP guidance and provider training materials. Six topics were prioritized: uptake, missed pills, side effects, discontinuation and switching, drug interactions and monitoring. Additional evidence and experts were consulted to answer outstanding questions and counseling recommendations for the DPP were developed. Missed pills was the topic with the most complexity, raising questions about whether women could “double up” on missed pills or skip the last week of the pack to recover protection faster. Uptake required aligning the time to reach protective levels for both DPP components and explaining the need to take DPP pills during week 4 of the pack. The potential intensity of DPP side effects, given the combination of oral PrEP with COC, was an important consideration. Discontinuation and switching looked at managing risk of HIV and unintended pregnancy when stopping or switching from the DPP. Guidance on drug interactions contended with differing contraindications for COC and PrEP. Monitoring required balancing clinical requirements with potential user burden.Actionable recommendationsThe working group developed counseling recommendations for the DPP to be tested in clinical acceptability studies. Uptake: Take one pill every day for the DPP until the pack is empty. Days 1–21 contain COC and oral PrEP. Days 22–28 do not contain COC to allow for monthly bleeding, but do contain oral PrEP and pills should be taken to maintain HIV protection. Take the DPP for 7 consecutive days to reach protective levels against pregnancy and HIV. Missed pills: If you miss 1 pill multiple times in a month or 2+ consecutive pills, take the DPP as soon as you remember. Do not take more than 2 pills in a day. If 2+ consecutive pills are missed, only take the last missed pill and discard the other missed pills. Side effects: You may experience side effects when you start using the DPP, including changes to monthly bleeding. Side effects are typically mild and go away without treatment. Discontinuation/switching: If you decide to discontinue use of the DPP, but want to be protected from HIV and/or unintended pregnancy, in most cases, you can begin using PrEP or another contraceptive method right away. Drug interactions: There are no drug-drug interactions from combining oral PrEP and COC in the DPP. Certain medications are not recommended due to their contraindication with oral PrEP or COC. Monitoring: You will need to get an HIV test prior to initiating or restarting the DPP, and every 3 months during DPP use. Your provider may recommend other screening or testing.DiscussionDeveloping recommendations for the DPP as a novel MPT posed unique challenges, with implications for efficacy, cost, and user and provider comprehension and burden. Incorporating counseling recommendations into clinical cross-over acceptability studies allows for real-time feedback from providers and users. Supporting women with information to use the DPP correctly and confidently is critically important for eventual scale and commercialization.

【 授权许可】

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© 2023 Segal, Harris, Carmone, Haddad, Hadigal, Hatzold, Jones, Lathrop, Mason and Mikulich.