Transcript No Slide Title

ICA FOUNDATION
International Contraceptive Access
March 2011
1
ICA FOUNDATION
• Public-private partnership between Population Council and Bayer Healthcare
Pharmaceuticals
• Not-for-profit registered in Finland in 2004
• Provides contraceptive products, e.g., levonorgestrel releasing intrauterine
system (LNG IUS) to public health organizations such as multilaterals,
governments, or NGOs for use in their programs
• Aims to serve the reproductive needs of women and families in resource-poor
settings in developing countries
• Member of the Reproductive Health Supplies Coalition
2
ASPIRATIONS OF ICA
• Learn from experiences on introduction strategies and service models
• Gain insight into transitions to new generation of products
• Understand role of health benefits in acceptability and use of IUS
3
LEVONORGESTREL
INTRA-UTERINE SYSTEM
• The LNG IUS contraceptive was developed in the 1970s by Population Council and
Bayer Oy, combining the best features of both oral contraceptives and the IUD.
• Product consists of a T-shaped plastic frame and white
cylinder shaped hormone reservoir around the vertical
arm of the frame, with two nylon threads for removal.
• The system contains 52 mg of the hormone
levonorgestrel (LNG) and releases 20µg/24h in the
uterus for up to five years of protection.
• Registered in 3 countries (Ghana, Kenya and Nigeria),
with pending registrations in several more countries
4
CHARACTERISTICS OF LNG IUS
• Effective: rate of unplanned pregnancy ~0.1% at
1year and less than 1% at 5 years
• High continuation rate: up to 85% at one year
• Significantly reduces menstrual blood loss
• Return to fertility after removal is 80% at 1year
• More cost-effective than oral contraceptives,
condoms and injectable contraception over five
years
5
LNG-IUS MECHANISMS OF ACTION
• Thickens cervical mucus
• Inhibits sperm function in uterus
• Reduces monthly growth of the lining of the
uterus making periods lighter and shorter*
* There is no evidence that the LNG-IUS can prevent implantation
6
ALTERNATIVE TO STERILIZATION
• Where sterilization services not available or not acceptable, IUS is as, or
more, effective than sterilization (8 vs. 13 failures per 1000 procedures
at 5 years)
• Reversibility reduces risk of regret among younger women
• Currently complementing female sterilization in northern Europe
Sources: Sivin, 2007; Mansour, 2007; Inki, 2007
7
TREATMENT FOR MENORRHAGIA
• Use of LNG IUS makes periods lighter, shorter and less painful (and may
include dysmenorrhea)
• Over 12 months, blood loss reduced by 80-96% in women with
menorrhagia
• Clinical improvement in associated anemia
• Hemoglobin levels rise 1.8g/L in one year of use with LNG-IUS, compared to a
decrease of 1.2g/L with Copper-T.
• Irregular bleeding or spotting common in first 3-6 months; 20% with
amenorrhea at 12 months
Sources: Luukkainen 1987; Rezan and Chi, 2007; Sitruk-Ware, 2007
8
SUBSTITUTE FOR WOMEN
AWAITING HYSTERECTOMY
Source: Lahteenmaki et al, 1998
9
ICA FOUNDATION INVENTORY
• The ICA Foundation offers donations of LNG IUS to public sector
• Donations of LNG-IUS make up to 1% of non-US market sales of Mirena®
10
CONCEPTUAL FRAMEWORK
Method
characteristics
Client
Health system
policies, programs
and providers
Family and
community
relationships
11
PRIORITY CLIENT GROUP
• Women who want long-term effective and reversible contraception
• Women with heavy menstrual bleeding or for whom Copper IUDs
are unsuitable
12
DONATION PROCEDURES
• Service delivery organization submit proposal to Foundation
• LNG IUS is registered or special permission to import product is sought
from country of donation
• Training materials are provided regarding LNG IUS insertion/removal
and comprehensive family planning provision and counseling
• LNG IUS is incorporated into existing service
delivery strategy
• Donation recipient provides updates on numbers
of insertions as well as progress and possible
challenges of distribution
13
ICA CUMULATIVE DONATIONS:
40 740 LNG IUS (Dec 2011)
Number LNG IUS
50 000
40 000
30 000
20 000
10 000
0
2005
2006
2007
2008
Number Donations per year
2009
2010
2011
Cumulative Donations
14
COUNTRY PROJECTS
Latin America
• Brazil
• Curacao
• Dominican Rep.
• Ecuador
• El Salvador
• Paraguay
• Saint Lucia
Africa
• Ethiopia
• Ghana
• Kenya
• Nigeria
• South Africa
• Zambia
Asia
• Bangladesh
• Indonesia
Upcoming Donations
• Lesotho
• Nepal
• Philippines
• Senegal
• Uganda
• Zimbabwe
15
ROLE OF NETWORKS
Partnerships with service delivery networks, such as Marie
Stopes International (MSI) or the International Planned
Parenthood Federation (IPPF) allow for efficient delivery of
LNG IUS in multiple countries through existing infrastructures,
and assist in meeting the Foundation’s objectives.
They potentially have greater capacity for training, supervision
and logistics management as well as meeting reporting
requirements.
16
BOARD MEMBERS
John Townsend (Chairman)
Population Council
Klaus Brill (Vice-Chairman)
Bayer HealthCare Pharmaceuticals
Demet Gural
Caroline Crosbie (Deputy Member)
Pathfinder International
Michael Holscher
Tracey Brett (Deputy Member)
Marie Stopes International (MSI)
Vanessa Cullins
Planned Parenthood Federation of America (PPFA)
Pamela Barnes
Roy Jacobstein (Deputy Member)
EngenderHealth
James Sailer
Rebecca Brodsky (Deputy Member)
Population Council
David Smith
Toan Tran (Deputy Member)
International Planned Parenthood Federation (IPPF)
Johanna Kouru
Bayer Oy
Annette Velleur (Deputy Member)
Bayer HealthCare Pharmaceuticals
ADVISORY MEMBERS
Luis Bahamondes
Unicamp
Katherine Williams
Annette Gabriel
KfW
Jeff Spieler
United States Agency for International Development (USAID)
Claus-Peter Janisch
Medical Consultant
Robert Zinser
Rotary International
SECRETARY
Joanna Holopainen
Bayer Oy
17
Who can apply for LNG IUS?
International development and public health organizations, such as multilateral,
governmental, or non-governmental organizations for use in their programs. LNG IUS
donations are not available for biomedical research purposes, including clinical trials.
How to apply?
Interested applicants should complete a project proposal form on ICA Foundation’s
website and submit it for assessment and approval.
For more information please contact ICA Foundation:
Mailing address: ICA Foundation, PO Box 581, FI-20101 Turku, Finland
E-mail: [email protected];
Website: http://www.ica-foundation.org
18