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Insights for Microbicides
Introduction
As data analysis of the Population Council–developed microbicide
Carraguard® begins, Council researchers are considering how an effective
microbicide should be made available to the women who most need it. A
successful microbicide would be a product—likely to be delivered in the
form of a gel, foam, ring, or cream—to reduce the transmission of HIV,
and possibly other sexually transmitted infections, when used during
intercourse. It would be a form of protection that women could initiate
and control, giving them an additional defense against HIV. (Currently,
the only woman-initiated preventive product is the female condom, which
so far has not achieved the widespread use health experts still work
toward.)
There are dozens of candidate microbicides currently under
development, several of which are slated to complete their safety and
efficacy trials in 2007.* If any of these products proves sufficiently
protective, the next steps are the manufacture and distribution of the
product.
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A successful product introduction must
include clear instructions on how to use it.
Photo credit: Bev Symmonds |
Given the novel nature of a microbicide product, there exists no
blueprint for its introduction and integration into couples’ lives or
into developing-country health systems. There are, however, relevant
experiences from other fields from which insights and evidence can be
gleaned and applied.
With that in mind, the Council convened a meeting in March of experts
in product development and introduction, direct-to-consumer marketing,
clinical trials, and developing-country reproductive health and HIV/AIDS
programming. Titled “Insights and Evidence from Product Introduction:
Lessons for Microbicides,” the day-long meeting at the Council’s New
York headquarters was moderated by Population Council program associate
Martha Brady, and attended by 45 leaders of two dozen government,
nongovernmental, advocacy, and donor organizations.
“The speakers brought immense experience in putting products into the
hands of consumers,” says Brady. “Our goal for the meeting was to be of
service to the microbicides field. Our goal for protection products is
to increase the number of protected acts of sex and thus the number of
women protected from HIV, which is also the key public health goal.”
Presenters at the meeting reviewed strategies that have been used in
introducing health technologies in developing countries to generate and
share ideas centered on the concept of building the platform for
microbicides. Some of the issues that would affect the introduction of a
microbicide product include how to explain its correct use (as emergency
contraception also requires); how to market a female-initiated
HIV-prevention product used during intercourse (as the female condom
is); and how to introduce a product—the microbicide—to be used in
conjunction with another product—the condom (as certain “packages” of
contraceptive products require).
Sharing their expertise, speakers discussed market segmentation and
product positioning; how complex messages are best communicated; and how
social marketing approaches are used to initiate new behaviors for
disease prevention. Questions that were raised and call for more
research include how women assess their own risk of contracting HIV, how
their assessments compare to their actual risk, and, if necessary, how
to educate them to make an accurate assessment and take appropriate
action.
Other areas that merit close examination concern the logistics of
distribution. How will women learn to understand the product and to use
it properly? And will they use it properly? The questions that were
raised gave Council researchers perspective as they develop plans to
introduce microbicide products to users.
“There is an urgent need for protection from HIV, and this discussion
was extremely valuable,” says Brady, “in recognizing questions we need
to ask and identifying key features that can help guide microbicide
introduction efforts.”
“Lessons for Microbicides” was the second Day of Dialogue sponsored
by the Council; the first, in October of 2005, explored ways of getting
medicinal products into the hands of the world’s poor. A 16-page report
from that event is available as a
PDF, and a report from the
microbicides event is expected this autumn.
*The data-collection stage of the
Council's Phase 3 trial of Carraguard has been completed. See
accompanying article "Carraguard trial
progresses to data analysis."
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