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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, GHSP-D-19-00062; 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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The interactive deterministic online modeling tool P4O allows users to estimate how changing the proportion of injectable progestins in the contraceptive method mix might affect HIV and maternal and child health outcomes. With careful consideration for women’s individual choices, policy makers and program planners may use country-specific results to help inform programming and policy decisions.

ABSTRACT

Background: Observational studies raise concern about a potential link between injectable progestin contraceptive use and HIV acquisition risk. This possible link is particularly relevant in sub-Saharan Africa where HIV risk is high and the method mix is skewed toward injectables. We developed the Planning for Outcomes (P4O) model (https://planning4outcomes.ctiexchange.org/) to predict changes in maternal and child health (MCH) and HIV outcomes that could occur if the proportion of injectables in the method mix is changed.

Methods: P4O incorporates evidence-based assumptions to predict yearly changes in unintended pregnancies, morbidity/mortality, HIV infections (women and infants), and anticipated health care costs associated with changing the proportions of injectable users in 22 selected countries. Users of this model designate all countries or a subset and adjust inputs including percentage of injectable users who discontinue, percentage of discontinuers who begin use of an alternative method, hazard ratio for HIV infection with injectable use, method mix used by injectable discontinuers, annual probabilities of method-specific pregnancy and mother-to-child transmission of HIV, condom effectiveness against HIV, risk of HIV during pregnancy, and HIV incidence among women of reproductive age.

Results: Illustrative results from all sub-Saharan African countries combined and from selected countries demonstrate the potential of P4O to inform program planning and procurement decisions. In countries with high use of long-acting reversible contraception, the removal of injectables from the method mix is associated with improvement in MCH and HIV indicators if most injectable users switch to more effective methods (e.g., implants). In countries with high use of short-acting methods (e.g., condoms), the model predicts mostly negative MCH outcomes.

Conclusions: Policy makers and program planners may use P4O to inform programming and policy decisions. In all scenarios, programmatic preparation to accommodate changes to the contraceptive method mix, considerations of how the individual desires of women will be addressed, and potential burden of anticipated MCH-related costs warrant advanced consideration.

  • Received: 2019 Feb 6.
  • Accepted: 2019 May 7.
  • © Lebetkin et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-19-00062

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Global Health: Science and Practice: 11 (1)
Global Health: Science and Practice
Vol. 11, No. 1
February 28, 2023
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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, GHSP-D-19-00062; 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, GHSP-D-19-00062; DOI: 10.9745/GHSP-D-19-00062
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