Estimating the hypothetical dual health impact and cost-effectiveness of the Woman’s Condom in selected sub-Saharan African countries

Abstract

BackgroundFemale condoms are the only currently available woman-initiated option that offers dual protection from pregnancy and sexually transmitted infections, including HIV. The Woman’s Condom is a new female condom designed to provide dual protection and to be highly pleasurable and acceptable.ObjectiveWe sought to estimate the potential dual health impact and cost-effectiveness of a Woman’s Condom distribution program in 13 sub-Saharan African countries with HIV prevalence rates >4% among adults aged 15–49 years. We used two separate, publicly available models for this analysis, the Impact 2 model developed by Marie Stopes International and the Population Services International disability-adjusted life years (DALY) calculator program. We estimated the potential numbers of pregnancies and DALYs averted when the Woman’s Condom is used as a family planning method and the HIV infections and DALYs averted when it is used as an HIV prevention method.ResultsProgramming 100,000 Woman’s Condoms in each of 13 countries in sub-Saharan Africa during a 1-year period could potentially prevent 194 pregnancies and an average of 21 HIV infections in each country. When using the World Health Organization CHOosing Interventions that are Cost-Effective (WHO-CHOICE) criteria as a threshold to infer the potential cost-effectiveness of the Woman’s Condom, we found that the Woman’s Condom would be considered cost-effective.ConclusionThis was a first and successful attempt to estimate the impact of dual protection of female condoms. The health impact is greater for the use of the Woman’s Condom as an HIV prevention method than for contraception. Dual use of the Woman’s Condom increases the overall health impact. The Woman’s Condom was found to be very cost-effective in all 13 countries in our sample.

Perceived confidence to use female condoms among students in Tertiary Institutions of a Metropolitan City, Southwestern, Nigeria

“…The desire for lifetime partners or “ true love ” amongst older participants may well explain the lower perceived confidence to negotiate with partners on sexual matters [ 29 ]. Lack of trust, loss of control, the likelihood of domestic violence, infidelity were highlighted as issues raised by our respondents that would reduce their perceived confidence in the event of unplanned sexual encounters ratifies what is documented in other studies [ 14 , 30 , 31 ].…”

Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review

“…1). These 60 peer-reviewed studies provided cost-effectiveness results for the following HIV prevention interventions: 14 studies on VMMC, 13 studies on PrEP, five studies on TasP, 15 studies on PMTCT, nine studies on other biomedical interventions, one study on behaviour change, and three studies on structural interventions [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74]. Among PMTCT studies, 14 considered Prong III strategies, while one focused on Prong II.

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Modeling and Cost-Effectiveness in HIV Prevention

“…In a Nigerian study, condom promotion was estimated to be the most cost-effective strategy for HIV prevention in serodiscordant couples (ICER $1,206/DALY averted), followed by the addition of treatment as prevention (ICER $1,607/DALY averted) and then the addition of pre-exposure prophylaxis (ICER $7,870/DALY averted) [11]. A study examining the benefits of the woman’s condom in sub-Saharan Africa found costs ranging from $107-$303/DALY averted, depending on the volume of demand and the country context [12]. …”