Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

07 February 2012

In Conversation with Kate Morrow: Of Microbicides, Sensations, and Adherence (Part 2)

Original content from the Mapping Pathways blog team

Kathleen (Kate) Morrow is a staff psychologist at the Miriam Hospital and an associate professor (research) of Psychiatry and Human Behavior at the Alpert Medical School of Brown University. She is driving two innovative microbicide projects – Project LINK and Project MIST. Kate is also a member of the IRMA Steering Committee.

(In Part 1 of this interview, Kate talked about Project LINK and how she got started down this career path.)

MP: Could you describe your work with Project MIST? How does it broaden the scope of your earlier work with Project LINK?

KM: Like Project LINK, Project MIST is also part of the Microbicides Innovation Program. I’m doing the acceptability piece on that project, whose Principal Investigator is Robert Buckheit at ImQuest BioSciences. Out of Project LINK, we understood that women could feel the differences among various gels well enough to discern, with their ratings, one product from another. The women finally had a choice to make at the end of the study. Their experiences impacted the product they chose – different women chose different experiences.

We’re in the process of completing LINK analyses now, and one of the things we feel like we don’t have a handle on is how gel volume would play into, and impact, a woman’s perception and experience with a product. So, if we had the exact same gel, but in different volumes, would she experience different things? That’s a question in the field as well – how much gel do we need to apply? That depends on the dosage, the amount of drugs in each measure of gel. That’s still an open question – and we decided we needed to answer that question from the perspective of the user, so that, if we could, we could optimize the volume for drug delivery, as well as the user experience.

And for me, the big question hanging out there was – what do the guys think? From LINK, we now know what women feel and what they think about those feelings and sensations, but we don’t have any understanding of what their male partners feel and how that will drive their preferences for gels.

Last but not least, MIST also gave us the opportunity to try a quick-dissolving film developed by Lisa Rohan at the University of Pittsburgh. So, we’re looking at those three issues in Project MIST: volume and the difference between a gel and a film with respect to user experiences, and exploring male sexual partners’ sensory perceptions and experiences. Like LINK, it’s a mix method study: this time we’re incorporating the male partners into the qualitative data mix to understand their experiences.  We’ll continue to use the validated scales from LINK.

MP: What inspires you?

KM: Well, to begin with, there’s the work itself. I mean, I do this work because I think it’s really important – I think it’s a piece that’s missing otherwise from the field. There are some of us who focus on things like sexual pleasure (Anne Philpott among them), but we have to understand the mechanisms of sexual pleasure – how do we help with that process? These projects, LINK and MIST, uniquely do that. We’re very unique in the fact that what we are trying to understand is which sensory perceptions and experiences impact willingness to use a product and hopefully, down the line, adherence to product use. That way, we can better create a formula that will not only deliver the drug well, but also will make the sexual experience one that people will want to have – so they’ll continue to use the product. What gets me excited every day is trying to figure out that puzzle, and hoping that in the long run this work will have a beneficial impact on the field and our ability to end the HIV epidemic.

But, you know, research can get drab, it can drag along…you meet your small goals often but the big end points don’t come, I think, as often as we’d like them to! So it’s the little things every day that keep us going. I think the thing that inspires me the most in that sense is my participants. Personally, they’re not getting any benefit out of doing these studies with my team – they know it’s a placebo study. But they come in, they try the products, they give us their opinions… To me, they’re the experts, they’re the ones that are the key to my success and my ability to get the data in this field.

Since we started LINK, we’ve seen more than 400 women walk through our doors saying, “I want to help you do this.” They tried all the different products – and I know they weren’t all pleasant! Yet, our retention rate in the studies is well over 90% – it’s a group of women who really want this to happen. They’re dedicated, they try to be as honest as they can…you know, frankly, we ask them some difficult questions. In the qualitative interviews, they’re sitting across from us telling us the story of their experience – and that can’t be easy to do. At some level it’s got to be a little uncomfortable to talk about your sexual experiences in such detail. And now their male partners are also on board. They all understand the medical necessity of the study. They understand that a pleasurable sexual experience is important to microbicides and their ultimate use. I am constantly amazed by our participants.

MP: As a behavioral scientist, what is your role in this process?

KM: Well, it’s possible (in fact, it’s probable) that we will not be able to make one, single ideal microbicide for women. Everybody likes different things in sex, and people like different characteristics. What we’d like to do is raise the floor – get rid of the absolute bad characteristics and make the properties and performances of these gels good enough for people to use them.

Once we end up with a tolerable gel and begin to move into uptake and access and use, what we can then do as behavioral scientists is educate women and their partners about the not-so-great characteristics that might remain but that have to be there in order for the drug to be efficacious. It’s a balancing act between the experience of the user and the efficacy of the product. At some point, we’re likely to run into “we need it to be like this for the efficacy, we can’t change that”. So then, as a behavioral scientist, I have to say, “Okay, if you can’t change that, what impact is it going to have on the user and how can I help the user to cope with that?”

So, there are two things going on for me: on one hand, let’s make the best one possible to begin with. Then, if there are things we can’t change due to efficacy, how do I help people deal with those remaining issues? Even though it’s not going to be perfect, there are still things we can do as behavioral and social scientists to help deal with those imperfections.

MP: What’s the hardest part about your job?

KM: Not having enough time in the day! There’s just so much to do. I’d like it to move a whole lot faster than it can – but that’s just what it is. Obviously, I wish that we were there already. But day in and day out, I love my work. I love the science. I’m very appreciative of my participants and the efforts that they put in. My team is amazing and I think we’re doing good work and that we’ll be able to contribute, ultimately, to a better microbicide.

MP: What are you most excited about for 2012?

KM: Finishing up the LINK data and figuring out which of our scales are most useful to us in the process of evaluating candidate gels. And, of course, continuing with and finishing MIST and incorporating the male partner experience into the mix. Down the road, I’m hoping that we start a project to do similar kinds of science around rectal microbicides both with men who have sex with men (MSM) and women. I’m keeping my fingers crossed that it will get funded and take off this year. I’m just really excited about moving forward and trying to keep all of us moving forward.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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