Drug-releasing vaginal rings for HIV/STI and pregnancy prevention: a review of recent advances and clinical applications

ABSTRACT

Introduction

Adolescent girls and young women (AGYW), as well as pre- and post-menopausal women globally would benefit from expanded choice to address their sexual and reproductive health (SRH) needs related to Human Immunodeficiency Virus (HIV), sexually transmitted infections (STIs) and pregnancy prevention. Lack of adequate preventative vaccines for HIV/STIs reinforces public health prioritization for options women may use to mitigate risk for infectious disease and unplanned pregnancy. Drug releasing intravaginal rings (IVRs) represent one such technology that has garnered attention based on the modality’s success as a pre-exposure prophylaxis (PrEP) delivery option in HIV risk reduction.

Areas covered

This article provides a synopsis of three IVR technologies in active clinical development for prevention of HIV, STI, and unintended pregnancy demonstrating advancements in terms of compatibility with a wide range of drug types with a focus on dapivirine-based silicone rings (International Partnership for Microbicides (IPM), tenofovir-based polyurethane rings (Conrad), and pod-based rings (Oak Crest Institute of Science)).

Expert opinion

The goals of IVR research are to reduce burdens of HIV/STIs and unplanned pregnancies. Through the evolution of IVR technologies, the potential exists to trigger integration of health-care services through formulation of products with multiple indications.

KEYWORDS:

• Intravaginal rings
• HIV prevention
• STI prevention
• contraceptives

Article highlights

• Addressing development of MPT configurations that target issues that are important to AGYW health will not only provide public health impact, but could also potentially reduce total costs associated with co-administration of multiple products for female genital tract indications.

• The degree to which IVR technology can be expanded more broadly for women’s sexual and reproductive health indications may reflect a parallel integration of women’s integrated health care, particularly in parts of the world where such health-care options are inadequate and health systems overburdened. IVR technology potentially represents a kind of reverse paradigm, where products lead healthcare system development driving the need for integration of services to be more responsive for the individual holistically.

• The ultimate goals of IVR research efforts are to reduce global burdens of HIV/STIs and unplanned pregnancy and with the ongoing evolution of IVR technologies, the potential exists to do this effectively.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The Oak Crest Institute of Science has received generous support from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH), CONRAD (through a Cooperative Agreement with the United States Agency for International Development (USAID), GPO-A-00-08-00005-00), and the International Partnership for Microbicides.CONRAD’s IVR research and development has been made possible by the generous support of the American people through USAID and The US President’s Emergency Plan for AIDS Relief (PEPFAR) under Cooperative Agreements with Eastern Virginia Medical School (GPO-A-00-08-00005-00, AID-OAA-A-10-00068, AID-OAA-A-14-00010, and AID-OAA-A-14-00011), as well as from NIH and The Bill & Melinda Gates Foundation.The International Partnership for Microbicides receives generous support from the German Federal Ministry of Education and Research (BMBF) through the KfW Development Bank, Irish Aid, the Ministry of Foreign Affairs of the Netherlands, UK aid from the UK Government’s Foreign, Commonwealth & Development Office, the American people through the US President’s Emergency Plan for AIDS Relief (PEPFAR) in partnership with the United States Agency for International Development (USAID), and the Bill & Melinda Gates Foundation.Wits RHI receives funding from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH), National Institutes of Mental Health (NIMH), the American people through the US President’s Emergency Plan for AIDS Relief (PEPFAR) in partnership with the United States Agency for International Development (USAID), and the Bill & Melinda Gates Foundation.The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of its funders.