ZIKA CONTRACEPTION ACCESS NETWORK · 9.2B Z-CAN COMMUNICATION PRESENTATION BUILDING A NETWORK OF TRAINED PHYSICIANS AND CLINICS Evidence-based Training 175 physicians and 304 sta˜

ZIKA CONTRACEPTION ACCESS NETWORK

9.2B Z-CAN COMMUNICATION PRESENTATION


3 PRIMARY PREVENTION STRATEGIES TO PREVENT BIRTH DEFECTS DUE TO ZIKA

• Eliminate mosquitos in the environment and prevent mosquito bites

• Protect pregnant women from sexual transmission of Zika virus

• Prevent pregnancy in women who choose to delay or avoid pregnancy during a Zika outbreak

The Zika virus outbreak poses very serious risks to pregnant women because Zika virus infection during pregnancy can cause microcephaly and other se-vere fetal brain defects. To prevent birth defects due to Zika virus infection there are three primary prevention strategies:


ZIKA VIRUS & CONTRACEPTIVE NEEDS IN PUERTO RICO

• Puerto Rico has the highest number of Zika virus infections in the US, including in pregnant women1

• Among all cases, most Zika virus infections (61%) were in non-pregnant women1

• Approximately 138,000 women in Puerto Rico are at risk of unintended pregnancy2

• The unintended pregnancy rates are higher in Puerto Rico than US overall (66% vs. 51%) 2,3

• The use of highly effective contraception (IUD or implant) in Puerto Rico is low 2

A primary strategy to reduce Zika-related pregnancy complications is to prevent pregnancy in women who choose to delay or avoid pregnancy

1 MMWR November 11, 2016 / 65(44);1219–12232 http://ajph.aphapublications.org/doi/10.2105/AJPH.2013.301416Puerto Rico Title V Application, 2010–2011.3 https://www.yumpu.com/en/document/view/29535515/needs-assessment-of-the-mch-population-2010-puerto-rico-title-v-


KEY STRATEGIES

• Increase physician awareness of the need to screen reproductive aged women at every encounter about their pregnancy plans during the Zika outbreak and provide access to contraceptive methods if they desire to delay or avoid pregnancy.

• Increase the supply of the full range of reversible contraceptive methods to physicians and clinics in Puerto Rico, including IUDs, implants, injections, pills, patches, vaginal rings, and condoms

• Increase education of physicians and clinic support staff (e.g., nurse, health educator) on client-centered contraceptive counseling.

• Increase training of physicians on the insertion and removal of Long Acting Reversible Contraceptive methods.

• Increase awareness among women and families of availability of contraception


BUILDING A NETWORK OF TRAINED PHYSICIANS AND CLINICS

Evidence-based Training175 physicians and 304 sta� trained

Zika 101Client-centered contraceptive counseling

IUD and implant insertionZ-CAN policies and procedures

Proctoring

Direct observation of counselingDirect observation of IUD placement

IUD and implant simulation

Review with team Z-CAN procedures, toolkitClinic infrastructure assessment

Clinic readiness certi�cation151 physicians approved

Clinic ready to place product orders and shipment


CHAIN OF CUSTODY FOR CONTRACEPTIVE METHOD DONATIONS FOR THE ZIKA CONTRACEPTION ACCESS NETWORK (Z-CAN)

Manufacturers donate contraceptive products to The National Foundation forthe Centers for Disease Control and Prevention (CDCF)

CDCF donates contraceptive product to Z-CAN physicians and clinics

Z-CAN Puerto Rico TeamProvide programmatic support to Z-CAN physicians and clinics

PharmaceuticalManufacturers

Determine quantity of donated products

Ship contraceptive products to licensed pharmaceutical distributor in Puerto Rico

PharmaceuticalDistributor

Receives contraceptive product donations

Secures contraceptives in temperature controlled

facility in Puerto RicoHolds and distributes

products to participating Z-CAN physicians/clinics

based on resupply requests

Z-CAN Physicians/Clinics

Receive contraceptive product donations

Manage inventory of shipment through systematic

tracking and monitoringProvide secure storage

Report use of product to CDC Foundation

Z-CAN Clients

Receive client-centered contraceptive counseling

Select contraceptive methodReceive method same-day

and at no cost


REACH OF THE Z-CAN NETWORK


PRELIMINARY DATA


Z-CAN PROGRAM DATA

177

21,124 42%

48% 28% 22%

42%

26.1 years

48%37%

50%

151 95%physicians trained to

provide Z-CAN services

Physicians approved for Z-CAN service

provision

Patients received same-day

contraceptive method

Initial visits

Private Insurance

As of September 01, 2017 Employed Student Unemployed

Bachelor’s Degree or Higher

Mean age

Marriedor Cohabitating

Single

Public Insurance


SUSTAINABILITY


CONTRACEPTION ACCESS SUSTAINABILITY• From the start in 2016, Z-CAN was envisioned as a short-term emergency re-

sponse to an urgent public health need.• Key components to sustainability

Supply• Trained providers• Availability of the full range of reversible methods• Sufficient contraceptive access points• Coverage for all components of contraception Demand• Women and families aware of the link between contraception and Zika prevention

• Women aware of the availability of contraceptive services who chose to prevent pregnancy


END OF PROGRAM• The last day of Z-CAN services was September 23, 2017• CDC Foundation and CDC have worked closely with the Puerto Rico

Department of Health and the Center for Medicare and Medicaid Services to share lessons learned to help transition to a sustainable contraception access program led within the territory.

• Supporting continued contraception access for women affected by Hurricane Maria


LESSONS LEARNED• Partnerships are critical to demand creation, implementation, and

distribution• Building clinic capacity takes time • Introducing methods that were previously unavailable requiresa shift in

clinical practice • Introducing same-day provision of methods required a shift

in clinic visit protocol • Clinic and physician proctoring was essential • Formative research was critical • Social marketing/media can be used to reach a large,

diverse audience of women• Z-CAN is a short-term emergency response; sustainability plans

need to be driven by champions in Puerto Rico • Federal partners can provide support

Documents

ZIKA CONTRACEPTION ACCESS NETWORK · 9.2B Z-CAN COMMUNICATION PRESENTATION BUILDING A NETWORK OF TRAINED PHYSICIANS AND CLINICS Evidence-based Training 175 physicians and 304 sta˜