At and Beyond the Horizon: New Technologiesto Increase Choice and Address Unmet Need
Panel on Unmet Need and Method MixInternational Conference on Family Planning
Addis Ababa, EthiopiaNovember 15, 2013
Jeff Spieler
Senior Technical Advisor for Science and Technology
Office of Population and RHBureau for Global Health
USAID/Washington
Rationale for improved and new methods
At the horizon: Improved contraceptive technologies
LNG-IUS
Sayana Press (Depo subQ in Uniject)
SILCS Diaphragm
Woman’s Condom
Beyond the horizon: New technologies
NES/EE Contraceptive Vaginal Ring (CVR)
Biodegradable Contraceptive Implants/Pellets
Multi-Purpose Prevention Technologies (MTPs)
New contraceptive methods Still Needed
Future challenges
Topics in this presentation
Health/side effects, 23%
Infrequent sex, 21%
Postpartum/breastfeeding, 17%
No access/high cost, 8%
Unaware of methods, 4%
Perceived subfecund, 2%
Source: Darroch et al, Guttmacher Institute, 2011.
Client-level reasons for non-use, women with unmet need for FP, 3 regions
LNG-IUS
Sayana Press (Depo subQ in Uniject)
SILCS Diaphragm
Woman’s Condom
At the horizon (within 5 years):Improved contraceptive technologies
Programs can apply to the International Contraceptive Access Foundation for free donations of the LNG-IUS at see http://www.ica-foundation.org/
The LNG-IUS: The best of both worlds
Oral contraceptives Intrauterine devices
• Highly effective
• Reduction of menstrual loss
• Reduction of pelvic inflammatory disease
• No daily motivation
• Long-acting
• Estrogen-free
• Rapidly reversible
Levonorgestrelintrauterine system
Highly effective/(when used correctly and consistently)
Reduction of menstrual loss Reduction of pelvic
inflammatory disease (PID)
Highly effective No daily motivation Long-acting (up to 5 yrs) Estrogen-free Rapidly reversible
Years
Levonorgestrel intrauterine system
Cu IUD
0 1 2 3 4 5
3
2
1
0
-1
-2
-3
-4
g/l
Change in hemoglobin during 5 years of use
Hormonal Intrauterine Contraceptive System
Depo-subQ Provera 104: New formulation for subQ injection New name 30% lower dose (104 mg vs. 150 mg) Rapid onset of action Same effectiveness, same length of protection
(>3 months) Approved by USFDA (2005) and EMA/UK
Uniject: Single dose, single package Prefilled, sterile, non-reusable Short needles for subQ injection – allows easier
use by non-clinical personnel/CHWs Compact; easy to use and store Potential for home- and self-injection Approved by EMA and LDC registration
forthcoming Available for roll-out in 2014; PK study on-going
for injection in arm; acceptability studies completed 2013
Potential “home run”
New formulation of Depo-Provera: Sayana Press (Depo-subQ in Uniject)
SILCS DiaphragmImage Credit: PATH/Patrick McKern.
Woman’s CondomImage Credit: PATH/Patrick McKern.
Two new female barrier methods: SILCS Diaphragm and Woman's Condom
New Technologies
NES/EE Contraceptive Vaginal Ring (CVR)
Biodegradable Contraceptive Implants/Pellets
Multi-Purpose Prevention Technologies (MTPs)
New contraceptive methods still needed
Beyond the Horizon (5-15 years): New Contraceptive Technologies
NES/EE Contraceptive Vaginal Ring (CVR): First long-acting method that is user-controlled Nestorone® / Ethinyl Estradiol 1-Year Ring
(Core Technology)
*Delivers NES/EE 150/15µg /day, 13 cycles of 3 weeks on followed by 1 week offFDA approval expected in 2015Developed by the Population CouncilSponsored by USAID, NICHD, WHO
8.4 mm (3/8”) in cross section58 mm (2 1/4”) in diameter
NES CoreNES Core
NES / EE CoreNES / EE Core
Biodegradable Contraceptive Implant/Pellet
Biodegradable Contraceptive Implant Pellets Effective contraceptive placed under
the skin
Similar to, but much smaller than, an implant
Easy to insert
Biodegradability would eliminate the need for removal at the end of one year BUT can be removed
Landscape analysis of manufacturers underway (FHI360)
“On demand” products: Used at the time of intercourse
Appropriate for women who have intermittent sex, or who would like more direct control over their own protection
Sustained release products: User-initiated, but do not require daily
action
Should increase adherence, and therefore overall effectiveness
Priorities for first-generation MPTs
Some additional methods would likely have immediate application if they were of low cost:
1.Non-hormonal, non-steroidal and/or non-estrogen containing OCs, or novel progestin-only OCs
2.Non-surgical methods of male and female sterilization
3.A highly effective and safe vaginal spermicide
4.Post-testicular methods for men
New Contraceptive Methods Needed
Short Term – Improve programs and access, and help women successfully use current methods
Medium Term - Improve current methods to address reasons for non-use, e,g., reduce side effects and make methods easier to use, including confidentially and during breastfeeding
Long Term - Develop totally new methods to offer new approaches to contraception that address women’s reasons for unmet need and discontinuation
Future Challenges