Why on earth should we continue to invest in the male condom? J. Stovera, J Rosena, N Carvalhoa, HS Friedmanb, M Coganb, a Avenir Health, b UNFPA and B Deperthesb 9th IAEN Pre-Conference, Durban, South Africa 16 July 2016 – Parallel Session F
Introduction
Male condom* protects against pregnancy and transmission of sexually transmitted infections(STIs), including human immunodeficiency virus(HIV)
As support and investment in condom programming stagnating globally, it is critical to document whether condoms continue to be strategic and costeffective investments for family planning(FP) and the prevention of HIV and other STIs.
Scope Analysis countries
o 75 Countdown to 2015 countries o 6 additional UNAIDS Fast-Track to 2030 countries
Timeframe o 2015-2030 Scenarios
Baseline: Condom use levels from 2015 are held constant 2015
Medium: Historical trends in condom use from 2016-2030
High: Scaling up condom use to meet all unmet need for FP and scale up condom use for HIV and STI prevention to 90% by 2016
2030
Triple Protection
FP condom users: those using condoms as primary method of family planning; also protected against HIV/STIs Condom users for HIV/STI protection: those at medium and high risk of HIV and STI transmission; no pregnancy protection
Using condoms for protection from unintended pregnancy (low risk of HIV/STI)
Using condoms for STI protection (medium and high risk of HIV/STI transmission; low risk for family planning)
Using condoms for HIV protection (medium and high risk of HIV/STI transmission; low risk for family planning)
Methodology: Number of Condoms Used and Needed Family Planning • Condom use: # of women of reproductive age x mCPR among all women x proportion of condom method mix among all women x 120 CYP • Condom need: # of women of reproductive age x [mCPR among all women + unmet need] x condom share x 120 CYP
HIV and STI Prevention • Condom use among key population groups: female sex workers (FSW), men who have sex with men (MSM), transgenders, prisoners, people with multiple partners, and sero-discordant couples • Condom need: 90% of risky acts covered
Gap in Condoms = Condoms needed – current condom use
Methodology: Cost per Condom Distributed • Public sector: $0.05 - $0.08 Weissman, 2014: RH Costing Tool Commodities, labor, program support
• Social marketing: $0.18 ($0.04 - $ 3.42) PSI, Annual Cost Effectiveness Report Commodities, distribution, packaging, promotion
Methodology: Effectiveness of Condoms Component Impact
Effectiveness
Source
Family planning
Unintended pregnancies averted
90%
Cleland, Ali, Shah, UNPD, 2006
HIV
HIV infections averted
80%
Weller and Davis, Cochrane Review, 2002
STIs
Cases averted: Syphilis Gonorrhea Chlamydia HSV-2
29% 56% 38% 29%
Holmes et al. Bull WHO, 2004
Findings: Condom Gap Current Use and Need for Condoms, 2015, billions 30
Current Use
Need 26.7
25
20
15
15.8 13.8
12.9 10
8.3
7.5
5
0
Family Planning
HIV/STI Prevention
Total
Findings: Total Cost of Condoms (billions US$, 2015-2030)
Baseline
Medium
High
Family Planning
$25
$26
$30
HIV and STI Prevention
$35
$35
$57
$15
$15
$16
$6
$6
$8
Transgenders
$1
$1
$1
Multiple partners
$12
$13
$30
$1
$1
$2
$1
$1
$1
$60
$62
$87
Sex Workers Men who have sex w men
Sero-discordant couples Prisoners
GRAND TOTAL
Findings: Incremental Cost (millions US$, 2015-2030)
Medium vs Low Scenario
High vs Low Scenario
$1,180
$5,170
HIV and STI Prevention
$718
$22,500
Total
$1,900
$27,600
Family Planning
Findings: Impact 2015-2030
Area
Impact
Family planning
420M births averted
HIV
17M infections averted
200M
STIs
730M infections averted
30M
Total
DALYs Averted (High-Low) 5M
240M
Findings: Total Condom Effectiveness (2015-2030)
Incremental Cost ($ millions)
Incremental Effectiveness (DALYs averted), millions Incremental CostEffectiveness Ratio (ICER)
Medium over Low
High over Low
$1,900
$27,600
6.2
240
$304 ($33 - $540)
$115 ($43 - $212)
Cost-Effectiveness of HIV/STI/FP Interventions (Cost/DALY averted, US$ 2015)
Published studies on other family planning, HIV and STI interventions show costs per DALY averted ranging from $3 - $1100
Discussion Condoms are highly cost-effective investments! Meeting all demand for condom use would have a large health impact!
Q&A
