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Lebetkin E, Steiner MJ, Sonneveldt E, Selim A, Feyisetan B, Ndugga BM, Munthali AW, Malkin M, Jallow F. Couple-Years of Protection Indicator: New Global Guidance for Updating Existing Methods and Adding New Methods. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300388. [PMID: 38589048 PMCID: PMC11057804 DOI: 10.9745/ghsp-d-23-00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Couple-years of protection (CYP) is an indicator that allows for monitoring and evaluating of family planning (FP) program performance through simple calculations. The CYP for each contraceptive method is calculated by multiplying the number of contraceptive commodity units distributed to clients over a 1-year period by a conversion factor that quantifies the duration of contraceptive protection provided per unit distributed. CYP calculations across methods were previously updated in 2000 and 2011, resulting in changes in methodology, factor inclusion, and specific methods. Since the 2011 update, changes and additions to the modern contraceptive method mix required new CYP conversion factors for 4 methods of contraception: Levoplant implant, progestin-only pills (POPs), Caya diaphragm, and the hormonal intrauterine device. METHODS We conducted literature reviews of both published and gray literature and consulted with experts to identify updated data on continuation rates, duration of efficacy, and method effectiveness for the 4 methods. New CYP conversion factors were calculated for the 4 methods either by using the same calculation used previously for the method considering new data or, for new methods, using calculations for similar methods. RESULTS New CYP conversion factors were assigned to the 4 methods of contraception covered in this update: Levoplant, 2.5 CYP per implant inserted; POPs, 0.0833 CYP per pack (i.e., 12 cycles per CYP); Caya diaphragm, 1 CYP per device, and hormonal intrauterine device, 4.8 CYP per device inserted. CONCLUSIONS CYP is an important indicator for FP programs. As new methods of contraception are developed and new evidence is generated for current methods, the indicator may need to be updated. A standard process for updating and documenting future CYP updates is recommended.
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Affiliation(s)
| | | | | | - Amani Selim
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | - Bamikale Feyisetan
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | - Baker Maggwa Ndugga
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | - A Wezi Munthali
- Public Health Institute Contractors with USAID Global Health Training, Advisory and Support Contract, Washington, DC, USA
| | | | - Fatou Jallow
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Rademacher KH, Sripipatana T, Danna K, Sitrin D, Brunie A, Williams KM, Afolabi K, Rasoanirina F, Ramarao S, Pfitzer A, Cain D, Simon M, Menotti E, Hazelwood A, Nwala AA, Saidu Z, Chowdhury R, Taiwo A, Chidanyika A, Ndirangu G, Steiner MJ, Lepine MC, Homan R, Saad A, Vivalo J, Dorflinger LJ. What Have We Learned? Implementation of a Shared Learning Agenda and Access Strategy for the Hormonal Intrauterine Device. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100789. [PMID: 36316136 PMCID: PMC9622288 DOI: 10.9745/ghsp-d-21-00789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/23/2022] [Indexed: 09/16/2023]
Abstract
In 2015, a global learning agenda for the hormonal intrauterine device (IUD) was developed with priority research questions regarding use of the method in low- and middle-income countries. In addition, members of the Hormonal IUD Access Group aligned on a strategy to expand access in the context of volunteerism and contraceptive method choice. This article synthesizes evidence generated since then and describes steps taken to address demand- and supply-side barriers to access. Findings demonstrated high continuation rates and satisfaction among hormonal IUD users that are comparable to other long-acting reversible contraceptives (LARCs). Across studies, a sizable number of users reported they would have chosen a short-acting method or no method at all if the hormonal IUD were not an option, which suggests that women did not see the hormonal IUD as interchangeable with other LARC options and thus it may fill an important niche in the market. With several countries now poised to scale up the method, resource mobilization will be key. On the demand side, investments in implementation research will be critical to understanding how best to launch and scale the method, while ensuring the sustainability of multiple quality-assured suppliers with affordable public-sector pricing will be necessary on the supply side.
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Affiliation(s)
| | | | - Kendal Danna
- Population Services International, Washington, DC, USA
| | | | | | | | - Kayode Afolabi
- Formerly of the Reproductive Health Division, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Devon Cain
- Clinton Health Access Initiative, Boston, MA, USA
| | - Morgan Simon
- Global Health Supply Chain Program-Procurement and Supply Management project, Washington, DC, USA
| | - Elaine Menotti
- United States Agency for International Development, Washington, DC, USA
| | - Anna Hazelwood
- Formerly of the Foreign, Commonwealth & Development Office; Now with Clinton Health Access Initiative, Monrovia, Liberia
| | | | - Zainab Saidu
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Anne Taiwo
- Marie Stopes International Nigeria, Abuja, Nigeria
| | | | | | | | | | | | - Abdulmumin Saad
- Formerly of United States Agency for International Development; Now with Bill & Melinda Gates Foundation, Washington, DC, USA
| | - John Vivalo
- United States Agency for International Development, Washington, DC, USA
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