2 Popular EC Products

PC4Schering

Postinor-2Gedeon Richter

Progestin-alone EC has Better Effectiveness Pregnancy rates (per episode)

Levonorgestrel (LNG) 1.1%

Yuzpe (Combined

Formulation) 3.2%

Progestin (LNg)-Alone EC has Fewer Side Effects

Vomiting Nausea

LNg 5.6% 23.1%

Yuzpe 18.8% 50.5%

Source: WHO 1998

The Necklace

Standard Days Method

Efficacy of SDM

Correct use (w/abstinence)

Correct use (abstinence + other method)

Correct + non-compliance

4.4

5.6

11.9

Pregnancy rate over 13 cycles

• “Generally regarded as safe (GRAS)” reclassify as active pharmaceutical ingredient

• Inexpensive, widely available, stable at several temperatures

• Sulphated polymer – high molecular weight, negatively charged – may block binding of pathogens to target cells

Carraguard - PC-515 (1)

• Population Council’s lead microbicide

• Derived from seaweed (carrageenan)

• Carrageenans used widely in food, pharmaceuticals & cosmetics as excipient

Microbicides in clinical trials Sept. 2002

0

2

4

6

8

10

Phase 1 Phase 2 Phase2/3 Phase 3

2002

When will we actually see a microbicide product for use in

programs?

Not for at least several years.

Female Condom

Inner ringOuter ring

Plastic sheathwith ring at both ends

Grasping female condomfor insertion

Reality and Reddy Female Condoms

Auto-Disable (AD) Syringes

• Automatic inactivation after single use

• Difficult / impossible to re-use

• Slightly more expensive

• Successful experience in immunization

• Starting to be shipped by USAID for Depo-Provera

What country in ANE/E&E has already had Depo shipped with

AD Syringes?

Jordan!

What ANE/E&E countires are Scheduled for AD Syringes in

2002-3?

• Afganistan, Bangldesh, Jordan, Nepal, Philippines, Egypt, WB Gaza

• Albania, Romania

CBD Workers….A. Can provide condoms

B. Can provide condoms and pills

C. Can provide condoms, pills and injectables

D. Can provide condoms, pills and injectables but certain quality components (e.g. side effect counseling, clean needle) key

N-9 Spermicides..A. Very effective for preventing pregnancy and

HIV.B. Very effective for preventing pregnancy but

not HIV.C. Effective against HIV but not pregnancy.D. Mediocre against pregnancy and not

effective against HIV.

Non-Menstruating FP Clients

A. Are only a small part of potential FP users.B. Should be told to go away and return when

they are menstruatingC. Should be given condoms and told to return

when they are menstruating. D. Can be given hormonal methods if

pregnancy is ruled out e.g. by the “Pregnancy Checklist.”

Syndromic Management of STIs

A. Not a sound approach to SITsB. Not a sound approach for cervical STI’s in

women such as gonorrhea and chlamydia, but effective for urethritis, and often for genital ulcers. May be sensible approach to vaginitis

C. Good for all STI syndromesD. A good approach for social marketing antibiotics

for urethritis.

According to WHO, how many pill packs should be given at initial visits?

A. 1 PackB. 3 PacksC. 6 PacksD. Up to 13 Packs (1 year)E. As many as client wants

IUDs

A. Can be safely provided to nulliparous women with proper screening

B. Require a follow-up only at about one month unless the client has problems

C. May be appropriate for HIV+ womenD. Do not increase the risk of infertility in well-

screened clients.

Nonfatal VenousThromboembolism May be More

Common with Third Generation Pills

Situation

Source: Vessey MP. BJOG 1997; 104:516.

No COC

Rate(per 100,000

women/years)

5 - 11

COC with Desogestrel or Gestodene (3rd generation)

COC with Norethisterone or Levonorgestrel

Pregnant and postpartum women

15

60

30

Types of MonthlyCombined Injectables

Cyclofem(Cyclo-Provera):

25 mg DMPA5 mg estradiol cypionate

Mesigyna(Norigynon):50 mg NET-EN

5 mg estradiol valerate

Comparative Characteristics of DMPA and NET-EN

Effectiveness

Bleeding

Needle/pain

Reinjection window

Duration

Cost

DMPA NET-EN

(no significant difference)

More amenorrhea

Smaller/less

2 - 4 weeks early or late

3 months

Less expensive

More irregular

Larger/more

1 - 2 weeks early or late

2 months

More expensive

54 mm

4 mm(1/8 in)

(2 inches)

EC:The Sooner the BetterWHO Pooled Data (Yuzpe and LNg)

0.5%

1.5%1.8%

2.6%3.1%

4.1%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

0-12 13-24 25-36 37-48 49-60 61-72

Pregnancy Rate

Source: Piaggio, von Hertzen, Grimes and Van Look 1999

p<.01

Actual Return of Menses Compared with Expected Return

0%

10%

20%

30%

40%

50%

60%

70%

<-3 -3 to +3 +4 to +7 >+7

WHOPop Council

Source: WHO 1998; Ellertson et al. 2001