1. 2 Popular EC Products
PC4
Schering
Postinor-2
Gedeon Richter

2. Progestin-alone EC has Better Effectiveness
Pregnancy rates (per episode)
Levonorgestrel (LNG) 1.1%
Yuzpe (Combined
Formulation) 3.2%

3. Progestin (LNg)-Alone EC has Fewer Side Effects
Vomiting Nausea
LNg 5.6% %
Yuzpe 18.8% %
This slide replaces former #8 (“side effects: combined ECPs” - which is the new #9) in ttt3
Source: WHO 1998

4. The Necklace Standard Days Method
How is the necklace used? (would any of you like to tell us how it is used?)
on the first day of menstrual bleeding, the woman moves this rubber ring to the red bead
on subsequent days she moves the rubber ring forward, one bead every day
when she is on a dark bead, she may have unprotected intercourse
when she is on a light colored bead, she should not have unprotected intercourse to avoid becoming pregnancy
when her menstrual bleeding starts again, she moves to the red bead and starts again
Standard Days Method

5. Pregnancy rate over 13 cycles
Efficacy of SDM
Pregnancy rate over 13 cycles
Correct use (w/abstinence)
Correct use (abstinence + other method)
Correct + non-compliance
4.4
5.6
11.9

6. “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

7. Carraguard - PC-515 (1) Population Council’s lead microbicide
Derived from seaweed (carrageenan)
Carrageenans used widely in food, pharmaceuticals & cosmetics as excipient

8. Sept. 2002 Microbicides in clinical trials Phase 1 Phase 2 Phase 2/32 4 6 8 10
Phase 1
Phase 2
Phase
2/3
Phase 3
2002

9. When will we actually see a microbicide product for use in programs?
Not for at least several years.

10. Grasping female condom for insertion
Plastic sheath with ring at both ends
Inner ring
Outer ring
Grasping female condom for insertion

12. Reality and Reddy Female Condoms

14. 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

15. What country in ANE/E&E has already had Depo shipped with AD Syringes?
Jordan!

16. What ANE/E&E countires are Scheduled for AD Syringes in 2002-3?
Afganistan, Bangldesh, Jordan, Nepal, Philippines, Egypt, WB Gaza
Albania, Romania

18. 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

19. 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.

20. 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 menstruating
C. 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.”

21. Syndromic Management of STIs
A. Not a sound approach to SITs
B. 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 syndromes
D. A good approach for social marketing antibiotics for urethritis.

22. According to WHO, how many pill packs should be given at initial visits?
A. 1 Pack
B. 3 Packs
C. 6 Packs
D. Up to 13 Packs (1 year)
E. As many as client wants

23. 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+ women
D. Do not increase the risk of infertility in well-screened clients.

27. Rate (per 100,000 women/years)
Nonfatal Venous Thromboembolism May be More Common with Third Generation Pills
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
Situation
The take-home message is that there are no advantages of the so-called “third generation” pills over the most commonly available low dose pills containing levonorgestrel or norethisterone.
Source: Vessey MP. BJOG 1997; 104:516.

28. Types of Monthly Combined Injectables
Cyclofem (Cyclo-Provera): 25 mg DMPA 5 mg estradiol cypionate
Mesigyna (Norigynon): 50 mg NET-EN 5 mg estradiol valerate

29. Comparative Characteristics of DMPA and NET-EN
Effectiveness
Bleeding
Needle/pain
Reinjection window
Duration
Cost
(no significant difference)
More irregular
More amenorrhea
Smaller/less
Larger/more
2 - 4 weeks early or late
1 - 2 weeks early or late
3 months
2 months
Less expensive
More expensive

30. 54 mm
4 mm
(1/8 in)
NuvaRing® is a combined contraceptive vaginal ring developed by Organon. It contains the estrogen, ethinyl estradiol, and the progestogen, etonogestrel.
NuvaRing® is a flexible, transparent ring made of the plastic Evatane (ethylene vinyl acetate) and has an outer diameter of 54 mm and a cross-sectional diameter of 4 mm.
(2 inches)

32. EC:The Sooner the Better WHO Pooled Data (Yuzpe and LNg)
Pregnancy Rate
Source: Piaggio, von Hertzen, Grimes and Van Look 1999

33. Actual Return of Menses Compared with Expected Return
Source: WHO 1998; Ellertson et al. 2001