Sayana Press: Pilot introduction and evaluation · PDF fileSayana ® Press: Pilot...
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Sayana® Press: Pilot introduction and evaluation
RHSC 14th Annual Membership meeting New Delhi, India 7-11 October 2013
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Product information and evidence
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Used with: • Hepatitis B vaccine • Oxytocin • Tetanus toxoid • Cyclofem In these countries: • Bolivia • Brazil • China • Egypt • Guatemala • India • Indonesia • Vietnam
Single dose Prefilled and sterile Non-reusable
Made by BD (Becton, Dickinson and Company)
Developed by PATH
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What is Uniject™?
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What is Sayana Press? How is it different from DMPA IM?
Saya
na P
ress
Sayana Press
• 104 mg DMPA. • Delivered every 3 months. • Prefilled in Uniject. • Subcutaneous injection. • 3/8” needle. • Site: subcutaneous fat. • Equivalent contraceptive
efficacy, safety, and side effects.
• Pfizer product: Patent until 2020.
Current standard
DMPA
IM 1
50
• 150 mg DMPA. • Delivered every 3 months. • Glass vial with syringe. • Intramuscular injection. • 1” needle. • Site: deep muscle tissue. • 99% contraceptive efficacy. • Depo-Provera® brand:
Pfizer, Inc. • Generic equivalents made
by various manufacturers.
DMPA IM 150
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Feat
ures
Be
nefit
s
Single, exact dose, all-in-one presentation
Subcutaneous injection
Non-reusable Reduced weight and volume
Simplified injection procedures
Simpler, shorter training
Eliminates mismatch of syringe/vial supplies
Easier to transport and store, less waste
to dispose
Improved injection safety
Valu
e Increased acceptability and use
by lower-level health care workers
Longer-term: Uniquely suited to
home and self-injection*
What are Sayana Press’ potential benefits?
*Sayana Press is not labeled for self-injection and does not have regulatory approvals for self-injection.
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Who might benefit from Sayana Press?
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Women without access to injectable
contraceptives
Women who prefer to obtain contraceptives
through commercial outlets
Hard-to-reach and special populations
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Comparison between Depo-subQ in Uniject and DMPA IM – Uganda (n = 38)
97%
3%
Easier to administer
Depo-subqin UnijectDMPA IM
89%
5% 3% 3%
Easier to dispose
Depo-subq inUnijectDMPA IM
No preference
Missing data
97%
3%
Easier to prepare
Depo-subqin Uniject
DMPA IM
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Client acceptability of Depo-subQ in Uniject
If given the choice, would select Uniject at next family planning appointment (versus DMPA IM, no preference, don’t know)
Uganda (n = 120)
n (%) 95% CI**
Senegal (n = 242)
n (%) 95% CI**
Post-injection 100 (83%)
76%, 91%
170 (70%)
64%, 77%
3-month follow-up* 85 (85%)
76%, 94%
110 (77%)
67%, 87%
*Data collection still on-going; preliminary result only includes 83% of expected data from Uganda and 59% expected data from Senegal **Adjusted for clustering of clients within providers
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Comparison between Depo-subQ in Uniject and DMPA IM – Senegal (n = 22)
86%
9% 5%
Easier to administer
Depo-subQin UnijectNopreferenceMissing
95%
5%
Easier to dispose
Depo-subQin Uniject
DMPA IM
100%
Easier to prepare
Depo-subQ inUniject
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What is the price of Sayana Press?
• Currently Sayana Press is more costly than DMPA IM. • Future price is unknown.
o New products are normally more costly than existing products. o Cost and price are influenced by demand and production volumes. o At current volumes, the price of Sayana Press is likely to be close to
double the price for Depo Provera ($0.78 to $0.99 per unit). o Donors and partners are strategizing to support possible longer-
term, affordable pricing for Sayana Press.
10/18/2013 Page 10
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Overview of pilot introduction initiative
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Pilot introduction of Sayana Press
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Goals • Support achievement of FP2020 goals by increasing injectable
contraceptive use. • Develop an evidence and experience base to inform global and
country-level decisions concerning whether and how to include Sayana Press as a contraceptive option.
Objectives
• Deliver up to 12 million units of Sayana Press in four to six countries in Sub-Saharan Africa and South Asia, 2013–2016.
• Expand access to injectables for new users, improve continuation, and reduce delivery costs.
• Evaluate the value proposition of Sayana Press: Inform decision-making about whether to include Sayana Press in family planning programs in the future.
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Pilot introduction of Sayana Press
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Product registration process • Sayana Press is approved by
stringent regulatory authorities in Europe.
• The drug in Sayana Press is approved by European regulatory authorities and by the US Food and Drug Administration (USFDA).
• The product will be registered in country before pilot introduction begins.
• Pfizer is responsible for preparing and submitting country registration dossiers.
PATH
/Eric
Bec
ker
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Pilot introduction—country implementation
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Introduction principles
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• Country ownership and collaboration with donors and implementing partners.
• Include Sayana Press in regular family planning distribution and delivery systems.
• Involve MOH personnel—trainers, supervision systems, community health workers and other providers.
• Begin forward planning for possible future procurement.
PATH
/Jes
sica
Flem
ing
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Country contributions
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Sayana Press
MOH trainers and supervision systems
Providers in regular delivery channels
Other support building on existing systems
Distribution and logistics systems
Photo: David Jacobs
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Service delivery channels
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Private sector
networks
•Providing services through social marketing in places where people normally shop—pharmacies, drug shops, and commercial outlets.
NGO outreach
•Includes community-based programs.
•Extending number of outreach points.
Public sector
•Includes community-based distributors and community health workers.
•Shifting tasks to less specialized cadres.
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Future decision-making about Sayana Press
10/18/2013 Page 18
Considerations •Meeting women’s reproductive intentions.
•Demand for family planning.
•Country goals. •Costs and benefits.
Countries
Donors
Sayana Press?
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Evaluation framework
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Evaluation framework
• The pilot introduction of Sayana Press evaluation component expects to assess the product’s ability to: o Generate new users. o Improve contraceptive continuation. o Reduce service delivery costs.
• Information from the evaluation will be made available to donors and partners to inform decisions about use of Sayana Press.
• Evaluation Technical Advisory Group (E-TAG) will oversee evaluation design, implementation, and data review.
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PATH
/Mon
ique
Ber
lier
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Challenges
• Price • Registration time lines • Complexity: multiple funding flows through multiple channels
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Opportunities • Lots of interest at global and country level • Strong country partnerships • Evidence for decision making • Possibility of expanding provider base • Possibility of self administration
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Thank You Jane Hutchings Director, Reproductive Health Program PATH