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WHO STRATEGIC RESPONSE TO ZIKA OUTBREAK, AND AN ASSESSMENT OF CONTRACEPTIVE SALES IN BRAZIL TO UNDERSTAND CHALLENGES IN ACCESS AND USE DURING ZIKA EPIDEMIC

M o a z z a m A li M D , P h D , M P H

May 12, 2018ESC Budapest, Hungary

D ep artm ent o f Rep ro d u ctive H ealth an d Research

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ZIK A V IR U S IS ST ILL A CO N C ER N• Zikavirus is endemic in parts of Africa, has

been reported in South East Asia and is becoming established in the Americas and Caribbean.

• At present, 84 countries, territories or subnational areas have reported evidence of vector-borne Zikavirus transmission

• WHO declared Zikaa public health emergency of international concern on 1 February 2016, later the task force declared to be no longer an emergency in November 2016

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• Overall, decline in cases of Zikainfection has been reported the global risk assessment has not changed.

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q I t i s s a m e v e c to r th a t t r a n s m its c h ik u n g u n y a , d e n g u e a n d y e l lo w f e v e r .

q P e o p le w ith Z ik a v ir u s d is e a s e c a n h a v e s y m p to m s in c lu d in g m ild f e v e r , s k in r a s h , c o n ju n c t iv i t is , m u s c le a n d jo in t p a in , m a la is e o r h e a d a c h e . T h e s e s y m p to m s

n o r m a l ly la s t fo r 2 -7 d a y s .

q P e r in a ta l , t r a n s f u s io n a n d s e x u a l t r a n s m is s io n h a v e a ls o b e e n d e s c r ib e d

q T h e r e is s c ie n t i f ic c o n s e n s u s th a t Z ik a v ir u s is a c a u s e o f m ic r o c e p h a ly a n d G u il la in -B a r r é s y n d r o m e . L in k s to o th e r n e u r o lo g ic a l c o m p lic a t io n s a r e a ls o b e in g

in v e s t ig a te d .

ZIKA VIRUS IS TRANSMITTED THROUGH THE BITE OF AN INFECTED MOSQUITO: AEDES AEGYPTI

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2007 – FIRST LARGE ZIKA OUTBREAKq First large Zika outbreak in

humans in the Pacific Island of Yap in Micronesia.

q Prior to this, no outbreaks and only 14 cases of human Zikavirus disease

q Under-reporting, due to the clinical similarities of (mild) illness symptoms associated with Zika, dengue, and chikungunya infections might also account for previous Zika outbreaks being overlooked.

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PREDICTED DISTRIBUTION OF THE AEDES AEGYPTI MOSQUITO

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WHO RESPONSE TO ZIKA VIRUS OUTBREAK

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WHO ZIKA STRATEGIC RESPONSE PLANREVISED FOR JULY 2016 – DECEMBER 2017

WHO’s RESPONSE1. W H O is su p p o rtin g co u ntries to co ntro l Z ika v iru s

d isease b y takin g actio n s o u tlin ed in th e “Z ika

Strateg ic Resp o n se Fram ew o rk": 2. En h an ce su rve illan ce o f Z ika v iru s an d p o tentia l

co m p licatio n s.3. D efin e an d p rio ritize research b y co nven in g exp erts

an d p artn ers. 4. Stren gth en cap acity in risk co m m u n icatio n to

en gage co m m u n ities to b etter u n d erstan d risks

asso ciated w ith Z ika v iru s.5. Stren gth en th e cap acity o f lab o rato ries to d etect th e

v iru s.6. Su p p o rt h ealth au th o rities to im p lem ent vecto r

co ntro l strateg ies a im ed at red u cin g A ed es m o sq u ito p o p u latio n s.

7. P rep are reco m m en d atio n s fo r th e c lin ica l care an d fo llo w -u p o f p eo p le w ith co m p licatio n s re lated to Z ika v iru s in fectio n , in co llab o ratio n w ith exp erts

an d o th er h ealth agen cies.

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WHO’s STRATEGIC RESPONSE FRAMEWORK

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RATIONALE - CONTRACEPTIVE SERVICES AND ZIKA EPIDEMIC

q Some health ministries in Latin American countries officially recommended to postpone or avoid pregnancy

q As with Ebola, it was suspected that facilities in the most affected regions lack the capacity to respond to the increased demand for the services

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ZIKA EPIDEMIC AND MAIN CONCERNS FROM SRHR PERSPECTIVE

q Many women planning to delay and postpone pregnancies will need contraceptive services, or those already pregnant may need safe abortion care

q The concern was that under this epidemic, access to family planning and safe abortion care programs will be lacking adequate infrastructure, supplies, and trained personnel who may not be able to provide good quality of care services to communities

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WOMEN, COMMUNITIES, AND HEALTH SYSTEMS IN THE CONTEXT OF ZIKA

q The goal is to strengthen the health system’s response to the sexual and reproductive health needs of the communities, and advocate for equitable access to essential reproductive health services.

– Rapid assessment of health facilities’ commodity availability and capacity to deliver SRH services, including contraception, abortion, postabortion care

– Qualitative studies to explore women’s, men’s, and healthcare service providers’ risk perceptions, needs, attitudes and practices related to pregnancy prevention, abortion care, pregnancy care, and care for affected children

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EXPECTED OUTCOMES

q Better understanding of the impact of ZIKV on contraception care programs at facility level to policy makers and health managers to develop and strengthen services to be more responsive to community needs.

q Identify gaps, and provide evidence to decision makers in safeguarding availability of services in affected areas.

q Provide a set of tools and the processes, which can applied in other settings, to assess health facility and system readiness to respond to health emergencies in future.

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CONTRACEPTIVE SALES IN THE SETTINGOF THE ZIKA VIRUS EPIDEMIC

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MAIN OBJECTIVES OF THE STUDY

q To assess the sales of contraceptive methods in Brazil, tracking it from before and through the ZIKV outbreak.

q We obtained information from all pharmaceutical companies based in Brazil about contraceptives sales in the public and private sectors

q Data between September 2014 and August 2016.

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METHODS

q We analyzed : 1. Oral contraceptives, i.e. combined oral

contraceptives (COC) and progestin-only pills (POP), and vaginal and transdermal contraceptives,

2. Injectable contraceptives, i.e. once-a-month and depot-medroxyprogesterone acetate,

3. LARCs and 4. Emergency contraceptive (EC) pills.

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KEY FINDINGS

• Monthly sales of COC, POP, patches and vaginal rings represent the major sales segment of the market, i.e. 12.7–13.8 million cycles/units per month (90%).

• The second largest group of sales was injectables, representing 0.8–1.5 million ampoules per month (9.5%).

• Following this, are LARC methods with sales of 37 000 –41 000 devices per month (0.5%).

• The EC pill sales were between 1.0 million and 1.3 million of pills per month.

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MONTHLY SALES OF CONTRACEPTIVES IN BRAZIL: SEPT2014 –AUG2016 IMPLICATIONS

• The results from this assessment showed that the sales of contraceptives presented little variation during the ZIKV outbreak in Brazil.

• It is possible that access to LARC methods was limited. We suspect that it is due to lack of availability of LARC in the public sector, the high cost of the methods and the incomplete insurance coverage on contraception for women.

• This assessment of contraceptive sales in Brazil identifies challenges in contraceptive access, especially for LARC methods, and – represents an alternative source of data to help us understand

the trends in demand for contraception in outbreak areas.

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SUMMARY: WHO RESPONSE TO ZIKA VIRUS OUTBREAK

• At present, 84 countries, territories or subnational areas reported evidence of vector-borne Zikavirus transmission

• WHO commits to long-term response to Zikaas ‘public health emergency’ is lifted.

• Overall, the global risk assessment has not changed. ZIKV continues to spread geographically to areas where competent vectors are present.

• Although a decline in cases of Zikavirus infection has been reported, vigilance needs to remain high.

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