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TECHNICAL NOTE
Open Access

Planning for Outcomes (P4O) Modeling Tool: Estimating the Impact of Changing the Proportion of Injectable Progestins in the Contraceptive Method Mix

Elena Lebetkin, Xiaoming Gao, Douglas Taylor, Lauren Y. Maldonado, Abdulmumin Saad, Markus J. Steiner, Laneta J. Dorflinger, Kavita Nanda and Timothy D. Mastro
Global Health: Science and Practice June 2019, 7(2):317-328; https://doi.org/10.9745/GHSP-D-19-00062
Elena Lebetkin
aFHI 360, Durham, NC, USA.
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  • For correspondence: elebetkin@fhi360.org
Xiaoming Gao
aFHI 360, Durham, NC, USA.
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Douglas Taylor
aFHI 360, Durham, NC, USA.
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Lauren Y. Maldonado
aFHI 360, Durham, NC, USA.
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Abdulmumin Saad
bUnited States Agency for International Development, Washington, DC, USA.
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Markus J. Steiner
aFHI 360, Durham, NC, USA.
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Laneta J. Dorflinger
aFHI 360, Durham, NC, USA.
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Kavita Nanda
aFHI 360, Durham, NC, USA.
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Timothy D. Mastro
aFHI 360, Durham, NC, USA.
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  • FIGURE 1
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    FIGURE 1

    Countries Included in the Planning for Outcomes (P4O) Model (N=22)

    a Countries with high injectable use and adult HIV prevalence >1% are depicted in dark orange.

    b Cambodia and Haiti are included in the model but not featured in the map above.

    c Countries with either high injectable use or high HIV prevalence are depicted in light orange.

  • FIGURE 2
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    FIGURE 2

    Model Flow Diagram

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    TABLE 1.

    Sources for Default Assumptions in the P4O Model

    MeasureSource
    Contraceptive prevalenceDemographic and Health Surveys10; Multiple Indicator Cluster Surveys11; Performance Monitoring and Accountability 2020 surveys12
    Pregnancy ratesContraceptive Technology13; Family Planning Global Handbook14; Adding It Up: Investing in Contraception and Maternal and Newborn Health15
    Probability of MTCTKuznik et al.16; World Health Organization17
    HIV prevalence and ART coverageJoint United Nations Programme on HIV and AIDS18
    Maternal mortalityMSI Impact 2 calculator (v.4)19
    Maternal and neonatal health costs; live births and abortionsAdding It Up: Investing in Contraception and Maternal and Newborn Health15
    • Abbreviations: ART, antiretroviral therapy; MSI, Marie Stopes International; MTCT, mother-to-child-transmission; P4O, Planning for Outcomes.

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    TABLE 2.

    Key MCH and HIV outcomes for All sub-Saharan African Countries and for Ethiopia, South Africa, and Zimbabwea

    IndicatorEthiopiaSouth AfricaZimbabweAll sub-Saharan Africab
    Yearly change in unintended pregnancies, No.
    Pregnancies824,933744,96351,3413,565,329
    Live births464,583374,10728,9141,911,731
    Abortions243,121269,12315,1311,155,684
    Unsafe abortions184,97671,16311,512749,343
    Yearly change in morbidity and mortality, No.
    Women with HIV−1,227−22,866−994−44,450
    Infants with HIV9885,56032916,068
    Maternal deaths2,75088316712,062
    Reallocated DMPA users per method, No.
    Pill149,344152,69830,606742,767
    IUD43,55927,486453179,190
    Male condom26,965357,3134,761823,462
    Implant495,73997,7279,1821,256,796
    Otherc37,3366,108340160,046
    Additional maternal and neonatal health care costs per year, US$35,112,706118,779,3702,185,284249,429,105
    • Abbreviations: DMPA, depot medroxyprogesterone acetate; HR, hazard ratio; IUD, intrauterine device; MCH, maternal child health.

      Note: We are updating the P4O model as new data become available. Thus, results produced may be different from results displayed in this table.

    • ↵a Assumptions: HR for HIV with DMPA=1.4; 75% of injectable users discontinue; 25% reallocate to other methods according to country-specific method mix after excluding permanent methods (sterilization); other parameters set to default.

    • ↵b Included sub-Saharan African countries: Botswana, Côte d'Ivoire, Ghana, Mozambique, Nigeria, South Sudan, Burundi, Ethiopia, Kenya, Lesotho, Liberia, Malawi, Namibia, Rwanda, South Africa, eSwatini, Tanzania, Uganda, Zambia, and Zimbabwe.

    • ↵c Other methods include emergency contraception, Lactational Amenorrhea Method, Standard Days Method, and other modern methods.

Additional Files

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    Files in this Data Supplement:

    • Planning for Outcomes (P4O) Model: Data Source References
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Global Health: Science and Practice: 7 (2)
Global Health: Science and Practice
Vol. 7, No. 2
June 24, 2019
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Planning for Outcomes (P4O) Modeling Tool: Estimating the Impact of Changing the Proportion of Injectable Progestins in the Contraceptive Method Mix
Elena Lebetkin, Xiaoming Gao, Douglas Taylor, Lauren Y. Maldonado, Abdulmumin Saad, Markus J. Steiner, Laneta J. Dorflinger, Kavita Nanda, Timothy D. Mastro
Global Health: Science and Practice Jun 2019, 7 (2) 317-328; DOI: 10.9745/GHSP-D-19-00062

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Planning for Outcomes (P4O) Modeling Tool: Estimating the Impact of Changing the Proportion of Injectable Progestins in the Contraceptive Method Mix
Elena Lebetkin, Xiaoming Gao, Douglas Taylor, Lauren Y. Maldonado, Abdulmumin Saad, Markus J. Steiner, Laneta J. Dorflinger, Kavita Nanda, Timothy D. Mastro
Global Health: Science and Practice Jun 2019, 7 (2) 317-328; DOI: 10.9745/GHSP-D-19-00062
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