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Condom

Latex male condoms are barrier methods which, when used correctly and consistently during sexual intercourse, reduce the risk of sexually transmitted infections, including HIV, and unintended pregnancy. PSI uses private-sector marketing strategies to increase demand for and access to attractively packaged and affordable high-quality male condoms.

Unit of intervention1 condom

TypeShort term contraceptive method

Target populationMale and female adults and older adolescents (15-19)

Increased access to family planning contributes to the overall health of women and their families, and reduces the need for abortion. For more information about how PSI is empowering women and couples to lead healthier lives, visit our website at:
http://www.psi.org/health-area/contraception/

Male condoms are an essential component of combination prevention for HIV. PSI implements a range of HIV prevention initiatives as part of its combination prevention approach. These include the marketing and provision of male and female condoms, HIV testing and counseling, voluntary medical male circumcision, and linkages to care, among others. For more information about these initiatives, visit our website at:
http://www.psi.org/health-area/hiv/

Model Overview

PSI’s male condom model can be broken into two distinct components: 1) modeling HIV-related impact and 2) modeling impact from family planning. The impact from both health areas (HIV and family planning) are added together to represent the full impact of condom distribution and promotion.

Component 1: Modeling HIV-related impact

PSI’s HIV condom model estimates the number of new HIV infections averted per condom and the number of HIV-related DALYs averted per condom. The model is designed with two core components: a baseline scenario in which the PSI condom intervention is NOT present, and an intervention scenario in which the PSI condom intervention IS present.

The model begins by using the Bernoulli probability theory to estimate an individual’s risk of HIV infection through sexual contact with discordant partners (i.e. the risk of an HIV-negative individual being infected from sexual contact with an HIV-positive individual). Specific risk factors taken into consideration include partner type, number of sexual partners and acts per partner. This is the baseline scenario for the likelihood of HIV infection.

The model then estimates the likelihood of HIV infection with increased condom use due to PSI’s intervention. All factors used to estimate the likelihood of HIV infection in the baseline scenario are the same with the exception of increased condom use. The likelihood of HIV infection in the intervention scenario is then subtracted from the likelihood of HIV infection in the baseline scenario to estimate the reduced likelihood of HIV infection as a result of the intervention. The Spectrum Suite software is used to create the scenario of increased use, in which country profiles are built in Goals and projected in the AIDS Impact Model (AIM).

Third, the model estimates the number of new HIV infections averted per condom. This is done by dividing the reduction in the likelihood of HIV infection by the number of PSI condoms used per person per year in the intervention scenario.

Output:
New HIV infections averted per condom

Finally, the model estimates the number of DALYs averted per male condom. The below equation is a simplified version of the calculation, which is modified to assume that a proportion of HIV positive individuals know their status and receive antiretroviral therapy (disability weights come from the 2010 Global Burden of Disease study).

DALYs averted per condom =

  1.        (new infections averted per condom x duration of HIV x disability weight of HIV)
  2.     + (new infections averted per condom x duration of AIDS x disability weight of AIDS)
  3.     + [new infections averted per condom x (life expectancy - age at death from AIDS)]
    1. Output:
      DALYs averted per condom

      Component 2: Modeling family planning-related impact

      The evidence for the impact of family planning on maternal and child health has been advanced by recent publications (see Volume 13, Supplement 3 of the 2013 BMC Public Health publication, “The Lives Saved Tool in 2013: new capabilities and applications” available here: www.biomedcentral.com/bmcpublichealth/supplements/13/S3 and (Volume 1, Issue 1371 of the 2015 Plos One publication, ‘Scaling up family planning to reduce maternal and child mortality: The potential costs and benefits of modern contraceptive Use in South Africa” available here: couple years of protection (CYP) conversion factors to represent the estimated protection against unintended pregnancy provided by contraceptive methods during one year. PSI does not modify these conversion factors when estimating CYPs provided.

      Service provision:

      When a client directly receives a family planning method from a PSI or PSI-affiliated provider during a consultation, PSI claims 100% of the impact of that service.

      Distribution:

      When PSI distributes a family planning method but does not provide it directly to a client, PSI claims 90% of the impact of that product, to take into account supply chain wastage.

      Referrals

      When a client is referred by PSI to a non-PSI service provider, such as the public sector, instead of providing the service itself, PSI claims 50% of the impact of that service. This impact is only attributed to PSI when the referral is confirmed with appropriate documentation.

      Model outputs (impact metrics)

      Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

      HIV model outputs

      • New HIV infections averted per condom
      • HIV-related DALYs averted per condom

      HIV examples based on distribution of condoms in Myanmar in 2015

      • 2015 New HIV infections averted per condom: 0.000066
      • 2015 HIV-related DALYs averted per condom: 0.003502

      Family planning model outputs

      • Deaths averted per condom
      • FP-related DALYs averted per condom
      • CYPs provided per condom
      • Unintended pregnancies averted per condom

      Family planning examples based on distribution of condoms in Myanmar in 2015

      • 2015 Deaths averted per condom: 0.000006*
      • 2015 FP-related DALYs averted per condom: 0.000478
      • 2015 CYPs provided per condom: 0.008333
      • 2015 Unintended pregnancies averted per condom: 0.001194

      Aggregated model output

      • DALYs averted per condom

      Aggregated example

      • DALYs averted per condom in Myanmar, 2015: 0.003981

      * We are able to produce deaths averted coefficients for maternal deaths and child deaths individually. Within PSI's Impact Calculator, these estimates are aggregated into a single estimate of deaths averted. Estimates of maternal deaths averted are available via the export function within the calculator

      Statement of modeled results, examples:

      If 1,000,000 condoms were distributed in Myanmar in 2015, an estimated 8,333 CYPs would be provided and
      66 new HIV infections, 6 deaths, 3,981 DALYs and 1,194 unintended pregnancies would be averted.