Tasked by the Gates Foundation, the University of Washington’s Strategic Analysis, Research & Training (START) Center conducted a comprehensive literature review to assess vaginally delivered drugs and therapeutics, including delivery platforms, efficacy, effects on the vaginal microbiome, and user and partner preferences. The review focused on evidence from low- and middle-income countries (LMICs) and synthesized findings from 106 published studies, the majority of which were conducted in Africa and Asia, particularly South Africa and India.
The review identified growing interest in leveraging established vaginal delivery platforms, such as rings, gels, creams, and tablets, to administer therapeutics traditionally delivered systemically. It also highlighted emerging innovations undergoing clinical evaluation, including nanoparticle-based delivery systems and vaccines targeting infections and cancers. Overall, the evidence demonstrated that most products were effective and had minimal impact on the vaginal microbiome.
User and partner preference studies revealed that product efficacy is a primary consideration, with greater acceptance of products that either enhance or do not interfere with sexual experiences. Findings also underscored the significant influence of male partners on product uptake and continued use, with partner acceptance often playing a decisive role in product selection.
Based on these findings, the START Center recommended expanding research to additional geographic and cultural settings to capture more diverse user perspectives, actively including men in future studies, and prioritizing product acceptability and real-world implementation considerations early in the product development process.
