A Global Learning Agenda for the Levonorgestrel Intrauterine System (LNG IUS): Addressing Challenges and Opportunities to Increase Access

Rademacher, Kate H.; Sripipatana, Tabitha; Pfitzer, Anne; Mackay, Anna; Thurston, Sarah; Jackson, A.; Menotti, Elaine P.; Traeger, Hayley

doi:10.9745/ghsp-d-18-00383

Cited by 19 publications

(31 citation statements)

References 22 publications

(37 reference statements)

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“…A new LNG-IUS product, Avibela, received notification of national regulatory approval in December 2019. At approximately USD 15 per unit (assuming an order of 100,000 units), the procurement price for Avibela will be substantially lower than that of other commercial LNG-IUS products currently on the market ( Table 1 ); however, at the USD 15/unit price, Avibela will still be approximately twice as much as the commodity price for contraceptive implants (which can be purchased for USD 6.90 - 8.50 per unit, depending on the implant) 7 , 29 . Given these considerations, as well as the feedback from providers about the importance of affordable pricing to clients, it will be important for the government in Nigeria and international donors to continue to seek strategies to further increase the affordability of the method.…”

Section: Discussionmentioning

confidence: 98%

“…A number of countries, including Nigeria, have used this donated product to support pilot introduction activities 6 . More recently, new, more affordable commercial LNG-IUS products have received regulatory approval in (see Table 1 ), suggesting there may be opportunities in coming years to further expand access to the method within the country 7 .…”

Section: Introductionmentioning

confidence: 99%

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Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery costs

et al. 2020

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Background: Several organizations in Nigeria are leading pilot introduction programs of the levonorgestrel intrauterine system (LNG-IUS). We conducted a qualitative assessment of providers’ experiences across the five programs and an analysis of service delivery costs in one program. Methods: We conducted 20 in-depth interviews (IDIs) with providers. We used project expenditure records to estimate incremental direct service delivery costs of introducing the LNG-IUS in 40 social franchise clinics supported by the Society for Family Health (SFH). We then compared the direct service delivery costs per couple years of protection (CYP) for the LNG-IUS to other family planning methods. Results: Providers appreciated the therapeutic benefits of the LNG-IUS, especially reduction of heavy bleeding. They said that women generally accepted bleeding changes with counseling but noted complaints about spotting and mixed acceptability of amenorrhea. Providers indicated being comfortable with both the insertion and removal process and believed their equipment and infection prevention protocols were adequate. Lack of awareness among women, limited availability, current pricing, and resistance to uterine placement among some women were perceived as barriers. The estimated direct service delivery cost of introducing the LNG-IUS in pilot settings, inclusive of up-front provider training costs, was USD 34 per insertion. Direct service delivery costs at a ‘steady state’ (i.e., without training costs included for any method) of the LNG-IUS per CYP was similar to that of other contraceptive methods distributed in Nigeria. Conclusion: Providers’ positive experiences with the LNG-IUS and direct service delivery costs per CYP that align with those for other methods suggest that the LNG-IUS could be an important addition to the method mix in Nigeria. Product introduction strategies will need to address both the supply and the demand sides, as well as consider appropriate pricing of the LNG-IUS relative to other methods and particularly the copper IUD.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery costs

et al. 2020

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“…This questionnaire also collected reasons for choosing the method, what method they would have chosen if the hormonal IUS or IUD was not available, and when and how they heard about the hormonal IUS, which are questions implementers in the global hormonal IUS consultative group all agreed to collect. 21 Consent was obtained immediately following insertion in Kenya due to initial plans to conduct follow-up interviews via short message service survey; however, the study team later opted for phone interviews instead. All women who gave a phone number were contacted for follow-up interviews.…”

Section: Methodsmentioning

confidence: 99%

“…This evidence contributes to the learning agenda developed by a global Hormonal IUS Consultative Group of donors, implementers, and suppliers. 21 …”

Section: Introductionmentioning

confidence: 99%

Expanding Contraceptive Method Choice With a Hormonal Intrauterine System: Results From Mixed Methods Studies in Kenya and Zambia

Sitrin

Pfitzer

Ndirangu

et al. 2021

Glob Health Sci Pract

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“… 6 Yet, the global landscape is changing: in 2015, a consortium of donors, governments, manufacturers, researchers, and service delivery groups initiated a collaboration to support expanded access to this contraceptive method. 7 Now, the US Agency for International Development and the United Nations Population Fund—the two biggest procurement agencies for family planning globally—have added the hormonal intrauterine device to their product catalogues for the first time and several countries, including Nigeria and Zambia, plan to introduce it as part of the contraceptive method mix in the public sector. 8…”

Section: Introductionmentioning

confidence: 99%

Expanding long-acting contraceptive options: a prospective cohort study of the hormonal intrauterine device, copper intrauterine device, and implants in Nigeria and Zambia

Brunie¹,

Stankevitz²,

Nwala³

et al. 2021

The Lancet Global Health

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Background 30 years after the introduction of the levonorgestrel-releasing intrauterine device in Europe, several sub-Saharan African countries are seeking to broaden access to this contraceptive method. In this study, we aimed to assess 12-month continuation of the hormonal intrauterine device, copper intrauterine device, and implants, as well as to assess women's experiences and satisfaction using these methods in the private sector in Nigeria and the public sector in Zambia. MethodsWe did a prospective cohort study of long-acting reversible contraceptive users across 40 private sector clinics in Nigeria and 21 public sector clinics in Zambia. Eligible women were aged 18-49 years in Nigeria and 16-49 years in Zambia, had chosen to receive the hormonal intrauterine device, copper intrauterine device, or implant (either a 5-year levonorgestrel-releasing subdermal implant or a 3-year etonogestrel-releasing subdermal implant), and, in Nigeria only, had access to a telephone. Women were interviewed within 100 days of receiving their contraceptive method either via telephone in Nigeria or in person in Zambia, with follow-up surveys at 6 months and 12 months. The primary outcomes were method-specific, 12-month continuation rates-ie, continuation rates of the hormonal intrauterine device, copper intrauterine device, and implant across Nigeria and Zambia. We used Kaplan-Meier methods to estimate the cumulative probabilities of method-specific continuation and a log-rank test to compare contraceptive methods. We analysed self-reported satisfaction and experiences as a secondary outcome. FindingsBetween June 25 and Nov 22, 2018, we enrolled a total of 1542 women (n=860 in Nigeria and n=682 in Zambia) receiving a long-acting reversible contraceptive. In total, 835 women (266 [32%] hormonal intrauterine device users, 274 [33%] copper intrauterine device users, and 295 [35%] implant users) in Nigeria and 367 (140 [38%] hormonal intrauterine device users, 149 [40%] copper intrauterine device users, and 78 [21%] implant users) in Zambia were included in the study analysis. The 12-month cumulative continuation rates were 86•8% (95% CI 82•1-90•4) for the hormonal intrauterine device, 86•9% (82•1-90•4) for the copper intrauterine device, and 85•0% (80•2-88•7) for implants in Nigeria. In Zambia, the 12-month cumulative continuation rates were 94•7% (89•2-97•4) for the hormonal intrauterine device, 89•1% (82•3-93•4) for the copper intrauterine device, and 83•1% (72•2-90•1) for implants. At least 71% of respondents across the timepoints were very satisfied with their method, and at least 55 (79%) of 70 reported having recommended their contraceptive method to someone else. Across the methods, the most commonly self-reported positive aspect of long-acting reversible contraceptive use at 12 months was effectiveness in Nigeria (range 93-94%) and long-lasting duration in Zambia (48-60%). Between 124 (50%) of 248 and 136 (59%) of 230 Nigerian participants and 26 (42%) of 62 and 66 (57%) of 117 Zambian participants reported nothing negati...

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A Global Learning Agenda for the Levonorgestrel Intrauterine System (LNG IUS): Addressing Challenges and Opportunities to Increase Access

Cited by 19 publications

References 22 publications

Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery costs

Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery costs

Expanding Contraceptive Method Choice With a Hormonal Intrauterine System: Results From Mixed Methods Studies in Kenya and Zambia

Expanding long-acting contraceptive options: a prospective cohort study of the hormonal intrauterine device, copper intrauterine device, and implants in Nigeria and Zambia

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