RP5 MPT Study

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PROJECT SUMMARY Adolescents assigned female at birth (AFAB) in the United States (US) have unmet needs for pregnancy and HIV prevention; 75% of pregnancies in adolescents are unplanned and 12% of new HIV diagnoses occur in youth aged 13-24 years AFAB. Sexual and gender minority (SGM) youth may have particular vulnerabilities and yet their sexual and reproductive health needs are often overlooked or misunderstood. Multi-purpose prevention technology (MPT) products that can simultaneously prevent pregnancy, suppress menses, and prevent HIV are desirable, may bring efficiencies to both users and healthcare systems, and may serve to improve uptake of HIV prevention products among youth. Early studies suggest that adolescents AFAB would prefer an MPT that is discreet and long-lasting, with injections being a preferred delivery modality. The success of cabotegravir (CAB) as the first generally safe and highly effective long-acting systemic agent for HIV prevention opens up opportunities for the development of an injectable MPT that combines CAB with an effective contraceptive, like levonorgestrel (LNG); LNG has been widely used and has an established safety track record. CONRAD has developed a first-in-class long acting systemic MPT that consists of a bioresorbable injectable depot and that employs a novel drug delivery technology to deliver both CAB and LNG together for at least three months, and possibly longer. Pre-clinical studies in rats and non-human primates show promise. To advance the development of this injectable CAB/LNG MPT our team with complementary expertise will conduct studies to 1) assess the values and preferences for a novel MPT for pregnancy and HIV prevention in adolescent cisgender women (CW) and transgender men (TM) AFAB aged 16-24 years in the USA, using a combination of qualitative interviews and participatory attitudinal ranking approaches to inform the selection of attributes and levels for a Discrete Choice Experiment to be conducted in a sample of 200 CW and 200 TM AFAB; and 2) conduct a multi-site, phase I, single arm PK trial of the CAB/LNG injectable biodegradable depot in a sample of 16 healthy, HIV-negative adolescents and young adults AFAB, ages 18-24, to assess the safety and pharmacokinetic profile of the products in CW and TM AFAB who are receiving gender-affirming hormone therapy. Incorporation of end-user preferences for MPTs early on in product development can enhance acceptability, optimize uptake and use, and ultimately ensure public health benefit. The evaluation of the safety, acceptability and pharmacology of a first in-human CAB/LNG biodegradable depot injection in CW and TM youth will ensure that data on adolescents across genders is available for regulators should co-formulated CAB/LNG move forward for licensure. The availability of a highly effective, long-acting MPT that places a premium on safety and acceptability in adolescents AFAB across genders, has the potential to accelerate access to effective sexual and reproductive health, to potentially address disparities in health access for SGM populations, and to have a substantial impact on the HIV epidemic.