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2011 CYP Update: Newly Calculated Factors

2011 CYP Update: Newly Calculated Factors. Process, Calculation, Justification, Implications. Outline. Process/Methodology used for the update Items included in factor calculations Look at methods through 3 categories Those with recommended changes New methods

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2011 CYP Update: Newly Calculated Factors

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  1. 2011 CYP Update: Newly Calculated Factors Process, Calculation, Justification, Implications

  2. Outline • Process/Methodology used for the update • Items included in factor calculations • Look at methods through 3 categories • Those with recommended changes • New methods • Those with no recommended changes from the 2000 CYP factors

  3. Process/Methodology Used for the Update • Peer reviewed literature review • Gray literature review • Online search engine (Rollyo) • Organizational and individual contacts • Secondary analysis of DHS data • Utilization of data from articles and analysis to determine justification of method updates • Selection of specific data/articles to be included in new estimates • Real world usage • Length of follow-up in studies • Impact of inclusion/exclusion of articles on estimates (continuation rates) • Method specific calculations • Consultative meetings throughout

  4. Factors Included in CYP Calculations • Use Effectiveness - all methods • Duration of use - long acting and permanent methods and Fertility Awareness Methods (continuation rates and age) • Coital Frequency - condoms, spermicides (coitus-dependent methods) • Consistency of Use - condoms, spermicides (coitus-dependent methods) • Wastage - pills, condoms, spermicides • Overlapping Coverage*- all methods in 2000 * Use of a method during postpartum amenorrhea

  5. Overlapping Coverage (Postpartum Amenorrhea) • 2000 estimates used secondary analysis of DHS data to estimate number of postpartum amenorrheic women using any method. * Percentage of women less than 6 months postpartum that are currently amenorrheic and using any method.

  6. Overlapping Coverage Updated analysis using DHS after 2004. Updated analysis using DHS after 2004. Going to disregard overlapping coverage during postpartum amenorrhea

  7. Methods with CYP Factor Changes • IUD • Implants • Sterilization • Natural Family Planning (Fertility Awareness Methods)

  8. IUD • 2000 USAID CYP Factor (with rounding): 3.5 CYP per IUD inserted • Equation: Average duration * effectiveness * proportion not overlapping 3.9 years * 96.4% * 97.4% = 3.6 • Justifications for recommending a change: • Change in average duration of use (continuation/discontinuation) • Eliminating effectiveness from the equation because it is included in average duration of use

  9. IUD Average Duration of Use • Calculated by fitting an exponential decay curve to the continuation data (R=ae-rt) • From 4 articles: • Ali et al. 2011 (secondary analysis of DHS data) • 2 WHO studies providing 12 years of follow up (clinical trials) • Jenabi et al. 2006 providing 1 month continuation rates • Uses Ali data for the first 3 years and then applies the curve from the WHO data to the Ali data for years 4-10. • Truncated at 5 and10 years • Average duration of use is 4.6 years • Compared to 3.9 years in 2000 • Changes CYP from 3.5 to 4.6 • CYP for 5 year IUD is 3.3

  10. Implants • 2000 USAID CYP Factor: 3.5 CYP per implant (Norplant) 2.0 CYP per implant (Implanon, added later) 3.5 CYP per implant (Jadelle, added later) • Equation: Average duration * effectiveness 3.6 years * 100% = 3.6 • Justifications for recommending a change: • Change in average duration of use (continuation/discontinuation) • Addition of Sino-Implant (II) • Eliminating effectiveness from the equation because it is included in average duration of use

  11. Implant Duration of Use • Calculated by fitting an exponential decay curve to the continuation data (R=ae-rt) • Uses Norplant data to estimate the curve • Based on 4 studies: 3 doing secondary analysis of DHS data and one study of real world use in Senegal* • Factors are for 3, 4, and 5 year implants. • Due to differences in country registration duration * Tuladhar et al. 1998, Fathonah et al. 2000, African Population and Health Research Center 2001, Ba et al. 1999

  12. Implant Duration of Use • 3 Year Implant: 2.4 years use • 2.4 CYP per insertion • 4 Year Implant: 3.0 years use • 3.0 CYP per insertion • 5 Year Implant: 3.6 years use • 3.6 CYP per insertion

  13. Sterilization • 2000 USAID CYP Factor: • Asia 10 CYP • Latin America 10 CYP • Africa 8 CYP • Near East/North Africa 8 CYP • Equation: Mean age at time of sterilization, discounted for reduced fertility due to age, adjusted for higher parity among women opting for sterilization • Justifications for recommending a change: • Change in mean age at time of sterilization

  14. Sterilization 2011 CYP Global Factor: 10

  15. Sterilization • Discussion Points: • Different methodological approaches • Fertility and parity adjustments (USAID) • Mortality adjustments (Marie Stopes) • Weighted averages used for regional estimates (Marie Stopes)

  16. Natural Family Planning • 2000 USAID CYP Factor: 2 CYP per trained adopter • Terminology change: Fertility Awareness Based Methods (FAM) • Standard Days Method (SDM) • Based on average duration of use- 1.5 years • 2011 CYP Factor: 1.5 CYP per trained adopter

  17. New Methods • Vaginal Ring • Contraceptive Patch • CYP of 15 for each, based on CYP for oral contraceptives

  18. Methods Without CYP Factor Changes • Oral Contraceptives • Condoms • Male • Female • Spermicides • Injectables • Depo • Noristerat • Cyclofem • Emergency Contraception

  19. Oral Contraceptives • 2000 USAID CYP Factor (with wastage adjustment): 15 cycles per CYP • Equation: Number required / effectiveness / proportion not overlapping 13 / 92.4% / 98.3% = 14 • Justification for No Recommended Change: • New effectiveness data does not support a change • No change in result with the elimination of overlapping coverage • No new data on wastage

  20. Condoms and Spermicides • 2000 USAID CYP Factor (with wastage adjustment): 120 units per CYP • Equation: Number required (coital frequency, consistency of use) / proportion not overlapping 98 / 94.1% = 105

  21. Condoms and Spermicides • Based on Rutenberg’s 1993 analysis: The Fertility Impact of Inconsistent Condom Use of Contraception. • Coital frequency of 5.6 based on secondary analysis of DHS data. • Assumes condoms are used for 50% of coital acts among those reporting themselves to be condom users.

  22. Condoms and Spermicides • Justification for No Recommended Change: • Coital frequency data is no longer collected in DHS so there is a lack of comparable data. • Minimal change from elimination of overlapping coverage. • No new data on wastage.

  23. Injectables • 2000 USAID CYP Factor: 4 doses per CYP (Depo Provera) 6 doses per CYP (Noristerat) 13 doses per CYP (Cyclofem) Equation (DepoProvera): Average duration (biologically) / effectiveness / proportion not overlapping 4 / 100% / 94.6% = 4 • Justification for No Recommended Change: • New effectiveness data does not support a change. • No change from elimination of overlapping coverage.

  24. Emergency Contraception • 2000 USAID CYP Factor (added later): 20 doses per CYP • Equation: CYP for Pills / effectiveness 15 / 75% = 20 • Justification for No Recommended Change: • Methodology developed after 2000 with input from various experts, no need to modify • New effectiveness data does not support a change.

  25. Methods Not Changing

  26. Methods with Changing Factors

  27. Issues for Discussion • Sterilization methodology • Free vs. sold condoms • Continuation differences by provider • Limitations of using DHS data

  28. www.respond-project.org

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