Final evaluation of the contraceptive research and development program (CONRAD) (936-3044)

The project is implemented by Eastern Virginia Medical School. Evaluation covers the period 1986-9/95 against an extended PACD of 5/97. Originally designed to bring promising, near-term leads from the basic research sector into clinical trials, CONRAD's mandate was expanded within the first few years to include research on heterosexual HIV/AIDS transmission, epidemiological and behavioral factors affecting transmission, and development of methods to reduce transmission of HIV/sexually transmitted diseases (STDs). Responding to the recommendations of the 1989 mid-term evaluation, there has been a substantial increase in funding for extramural projects, intramural basic research has been scaled back, and priority has been shifted to proposals offering near-term leads. The project's effectiveness has been enhanced by its relatively small size and by the high quality and commitment of its staff, and effective systems are in place for coordinating activities with those of other USAID cooperating agencies as well as with other U.S., international, and developing country institutions. CONRAD will soon have brought three new barrier methods to the contraceptive market. It has also produced promising leads in methods for lactating women, a new vaginal film product (BZK), and some promise for male methods. An important achievement has been the intramural development of tests for spermicidal agents and support of the Southern Research Institute (SRI) for virucidal screening. The recently funded TOPCAD (Topical Prevention of Conception and Disease) project should bring improved coordination to the screening program and add screening for anti-gonococcal and chlamydial activity. The addition of HIV/AIDS research has complemented the contraceptive research program. CONRAD's successful development of a simian model of heterosexual transmission, as well as its contributions to understanding of the physiology of HIV infection in the human genital tract, provide important avenues for better evaluating the impact of contraceptive methods on disease transmission. Several areas for improvement are noted. It is strongly recommended that CONRAD establish a small strategic planning or policy unit to ensure development of long-term plans, oversight of Technical Advisory Committee (TAC) appointments, and annual program review; such a unit is critical to CONRAD's institutional visibility. It is also recommended that: (1) better and clearer mechanisms be established to ensure responsiveness to developing country needs; (2) the USAID mandate for rapid product development be relaxed in order to increase opportunities for exploration of long-term leads; and (3) the HIV/AIDS portfolio be streamlined and more clearly focused. Expecting the program to increase its already considerable contributions to the field of fertility regulation and reproductive health, the evaluation team strongly recommends that the CONRAD program be extended for another 10 years and that this continuation not be competed. (Author abstract, modified)