This document discusses strategies for improving women's reproductive health through expanding access to key health technologies. It outlines several approaches needed for successful introduction of new reproductive health products, including demonstrating pilot project success, health systems strengthening, and stakeholder engagement. The document then summarizes the burden of women's reproductive health issues and several underutilized technologies, such as microbicides, female barriers, emergency contraception, and cervical cancer prevention strategies. For each technology, it discusses research efforts, potential public health impacts, challenges to wider adoption, and strategies to increase impact and access.

1. Improving women's
reproductive health
through expanding
access to key health
technologies

2. For maximize impact, new RH
product introduction requires:
• Clear and understood health needs
• Safe and effective product/approach
• Demonstrated pilot project success
• Health systems strengthening
• Engagement of and support among
stakeholders at various levels
• Global and regional advocacy

3. Introducing new interventions or
products for maximum impact
Advocate for evidence-
based change
Disseminate lessons
and tools
Assess needs
Harmonize with communities
and existing health care systems
Design and implement
interventions
Evaluate acceptability
and performance
Involve stakeholders
Build capacity
Monitor quality
Maximize impact

4. Burden of women’s RH health
includes
• 122 million women (1/3 are women 15-24 yr
old) have an unmet need for contraception
• 37 million HIV+ people worldwide; females
make up over 60 percent of HIV+ 15-24 year
olds; 75 percent in sub-Saharan Africa
• 500,000 maternal deaths occur each year
(70,000 from unsafe abortion)
• Almost 500,000 new cases of cervical cancer
each year, 85 percent in the developing world

5. New and/or underutilized RH
technologies and interventions
• Microbicides
• Female barrier methods
• Emergency contraception
• Cervical cancer prevention
strategies

6. 1. Microbicides: search for a safe &
effective STI protection product
Substances that reduce risk of transmission
of HIV, STI pathogens when applied
vaginally and, possibly, rectally
Current research - gels or creams
applied with an applicator
Future formulations - sponges, time-
released vaginal rings, gels combined with
cervical barrier devices

7. Potential public health impact
If a 60% effective product,
offered to 73 lower income countries,
is used by 20% people reached by health
care,
during half of unprotected sex acts
2.5 million HIV infections would be
averted in 3 years

8. Laboratory
Testing
2 - 6 Years
Phase III
(effectiveness
)
2 - 4
Years
Simultaneous studies:
HIV+, penile & rectal
10 or more years
5
products2
products10
products10 - 20
products
Phase I
(safety)
1 - 6
Months
Phase II
(safety)
Up to 2
Years
25 - 40
people
200 - 400
people
3,000 -
10,000
people
The product pipeline

9. What do these trials cost?
Laboratory
Testing
Phase I
(safety)
Phase II
(safety)
Up to $13 Million
Phase III
(efficacy)
Up to $50
Million
Visit www.global-campaign.org

10. 2. Female condoms: build broad
stakeholder support and launch large-
scale demonstration projects
• Only female-initiated method currently
available for STI prevention, available in
over 100 countries
• As effective as a male condom for
pregnancy and STI prevention, and
acceptable to many couples
• But…12 million FC distributed annually
compared to 6 to 9 billion male condoms

11. Existing Products

12. Why not more widely used?
• Lack of political will and donor support
• Acceptability issues with first-generation
product
• Stigma (identified with sex workers)
• Product cost, limited product options
• Social context of women's lives (gender
issues, ability to negotiate use, access)

13. How to increase impact
• Advocacy to boost funding for introduction
so women’s protection is a viable option
• Fund demonstration projects to answer
ongoing questions about impact and
acceptability
• Develop collaborations to share research
and program tools
• Accelerate development and approval of
next-generation female condoms

14. PATH Woman’s Condom:
Performance Objectives
• Easy to handle and insert
• Easy to use (especially for new users)
• Stable during use
• Comfortable for both partners
• Easy to remove
• Less expensive than current options

15. PATH Woman’s Condom
• Soft-cling foam ellipses provide stability and comfort for a wide
range of users
• Insertion “capsule” makes insertion easy

16. 3. Emergency Contraception: build
awareness and systems support
• Emergency contraception is more effective
the sooner it is taken, up to 120 hours
after unprotected intercourse.1
• Progestin-only regimen reduces
pregnancy risk 89%
• Combined estrogen/progestin regimen
reduces pregnancy risk 75%2
1. Von Hertzen, H. et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception:
a WHO multicentre randomized trial. Lancet 360(9348):1803-1810 (2002). 2. WHO Task Force on
Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the
Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 352(9126):428-433 (1998).

17. Emergency Contraceptive Pills
(ECPs)
ECPs can prevent unintended pregnancy,
BUT
Due to low awareness:
• ECP product availability is restricted
• Health providers don’t offer it to clients
• Women don’t know to ask for it

18. Systems support: pharmacies as
alternative providers of RH needs
• Experience in
Cambodia, Kenya, and
Nicagagua:
• Pharmacy staff are key
primary health providers1
• Clients appreciate easy
access
• Pharmacy schools and
networks support
offering RH services
1
Data from Food and Drug Administration, Ministry of Public Health, Thailand says that 70% of patients receive services
from drugstore. PATH Thailand.Drugstore Capacity-building Programs:A Chronicle of PATH Experiences. 2000.

19. Increase ECP access through
building awareness
Communicate key messages to 3 key audiences:
• Evidence-based safety and effectiveness
information for policy and decision makers
• Technical information and counseling skills
for health providers and program managers
• Where to find and how to use ECPs for
women who need them.
Visit www.cecinfo.org

20. Logos and posters

21. Job aids

22. Client materials

23. Cervical Cancer Prevention: a
holistic approach
Focus areas:
• Screening and
treatment technologies
• Service delivery
guidelines
• Community needs and
involvement
• Advocacy
*PATH, EngenderHeatlh, PAHO, IARC, JHPIEGO
*
Visit www.alliance-cxca.org

24. VIA-positiveVIA-positive VILI-positiveVILI-positive
aa

25. HPV Testing: a new product on the
horizon: START (Screening Tests to Advance
Rapid Testing)
Existing test START test
Assay time 4-7 hrs ~ 2 hours
Accuracy 95% sens/85% spec At least comparable
Plastic consumables Multiple steps Greatly reduced
Reagent stability Requires refrigeration
at 4°C
Stability for >90 days at
40°C
Instrumentation
(heater/shaker)
Large footprint, non-
portable
Portable prototype
completed
Results readout Luminometer Prototype instant-film
holder

26. Findings
• Demand for cervical
cancer prevention
services is strong
among women and
communities.
• Organized prevention
programs are feasible
and can be integrated
with existing services.

27. Findings
• Test characteristics
of HPV testing and
visual-screening
approaches are
acceptable
in a range of settings.
• Cryotherapy is safe
and effective, and
can be delivered by
mid-level providers.

28. Findings
The single-visit
screen-and-treat
approach is safe and
effective in low-
resource settings.
This is a major
paradigm shift in
cervical cancer
prevention.

29. HPV vaccine news headlines
• “Vaccine prevents most cervical cancers.” - New York
Times, October 7, 2005.
• Vaccine proves 100 percent effective in preventing
cervical cancer – Seattle Times, October 6, 2005.
• “Promising new vaccines could wipe out cervical
cancer. But they must be administered to preteens,
and some groups oppose that.” – Philadelphia
Inquirer, July 4, 2005.
• “OK Roll up your sleeve; new vaccines are arriving
but the economics are still a challenge” –Business
Week, July 25, 2005.

30. The HPV-cervical cancer link
• Human papillomavirus (HPV) is a very common
infection (more than 50% of adults get it, in most it is a transitory
infection).
• 99.7% of cervical cancer cases are associated
with HPV.
• Progression from HPV infection to cancer
usually takes 20-30 years.
• Currently, there is no treatment for HPV
infection.

31. Global distribution of HPV types in
cervical cancer
53%
15%
9%
6%
3%
14%
HPV 16
HPV 18
HPV 45
HPV 31
HPV 33
HPV others

32. HPV vaccine opportunity
• 2 vaccines protecting against HPV 16 and 18
are nearing licensure.
• Both have high efficacy in Phase II trials and
appear very safe.
• Phase III trials will involve over 50,000 women
worldwide.
• Both manufacturers express interest in serving
developing country markets.

33. But….
Can vaccines be made broadly accessible
to the young women who need them the
most, given challenges around product
supply, information needs, delivery system
weaknesses, and community awareness?

34. PATH’s HPV vaccine focus
Advance HPV vaccines and
promote evidence-based cervical
cancer prevention approaches:
• Public-private sector
partnerships
• Country demonstration projects
• Forecasting and financing
efforts
• Policy and advocacy programs

35. Introducing new interventions
and/or products
Advocate for evidence-
based change
Disseminate lessons
and tools
Assess needs
Harmonize with communities
and existing health care systems
Design and implement
interventions
Evaluate acceptability
and performance
Involve stakeholders
Build capacity
Monitor quality
Maximize impact

36. Jacqueline Sherris, PhD
Strategic Program Leader,
Reproductive Health
sherris@path.org
www.path.org