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Author: Catherine Packer


Testing a counseling message for increasing uptake of self-injectable contraception in southern Malawi

A mixed-methods, clustered randomized controlled study

Objective: While self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) has well-documented benefits, uptake may be improved by addressing client concerns such as fear of self-injury and low self-efficacy. However, current training materials for family planning providers do not address these concerns. We used an iterative process with family planning providers and clients, male community leaders and partners, and stakeholders in Malawi to develop a counseling message addressing user-centered concerns about self-injection. We report on our testing of the effectiveness of this evidence-based message for increasing self-injection uptake in the context of full method choice.

Methods: We randomized 60 public facilities across two districts in southern Malawi to orient their providers to the message (treatment) or not (control). After strengthening data quality, we extracted routine service delivery data from the facilities six months before and after introducing the message. We compared pre- and post-orientation trends for the treatment and control groups using generalized linear mixed models. We conducted eight focus group discussions with a sample of providers oriented to the message.

Results: The message was feasible to implement and highly acceptable to providers. During June 2020–June 2021, 16,593 new clients used injectables in Mangochi district (52% DMPA-SC; 15% self-injected). In Thyolo district, 7,761 new clients used injectables during July 2020–July 2021 (29% DMPA-SC; 14% self-injected). We observed high variability in number of clients and self-injection uptake across facilities and over time, indicating inconsistent offering of self-injection. In both districts, we found significant increases in self-injection in treatment facilities after message introduction. However, this increase was not sustained, especially when DMPA-SC was unavailable or about to expire.

Conclusion: Based on the study findings, we recommend the evidence-based message be used in programs offering DMPA-SC self-injection services. However, effective use of the message is contingent upon a consistent supply of DMPA-SC.

Institutional author(s): FHI 360, Centre for Health, Agriculture Development Research and Consulting
Individual author(s): Holly M Burke, Catherine Packer, Akuzike Zingani, Philemon Moses, Alissa Bernholc, Lucy W Ruderman, Andres Martinez, Mario Chen
Publication date: October, 2022

Journal article PLoS ONE

Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi

Implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

Self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is poised to increase access to contraception; however, governments are concerned about the waste management of used units. Self-injectors in Malawi and Uganda are currently instructed to store used units in containers and return them to health workers for disposal. However, this may not be feasible in low-resource settings, especially for younger or covert self-injectors. We describe adolescent (15–19 years) and adult (20–49 years) self-injectors’ disposal experiences in Uganda and Malawi. When possible, we compare covert and overt users’ experiences.

Institutional author(s): FHI 360
Individual author(s): Holly M Burke, Catherine Packer, Laura Wando, Symon Peter Wandiembe, Nelson Muwereza, Subarna Pradhan, Akuzike Zingani, Bagrey Ngwira
Publication date: August, 2020

Journal article Reproductive Health journal

Client and provider experiences with self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in Malawi

As low- and middle-income countries (LMICs) consider adding self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) to their contraceptive method mix, learning about family planning clients’ and providers’ experiences with self-injectable DMPA-SC during trials will inform introduction and scale-up efforts. We conducted semistructured interviews with 30 randomly selected adult women enrolled in the self-administration group of a 12-month randomized controlled trial studying DMPA-SC continuation rates in rural Malawi. We asked about their experiences learning to self-inject, self-injecting, remembering when to reinject, and storing and disposing of DMPA-SC. We also interviewed 12 providers — clinic-based providers (CBPs) and community-based health surveillance assistants (HSAs) — who trained clients to self-inject DMPA-SC during the trial. We asked about their experiences training and supporting women to self-inject DMPA-SC during the trial and their recommendations for scale-up of self-administered DMPA-SC.

Institutional author(s): FHI 360, College of Medicine, University of Malawi
Individual author(s): Holly M Burke, Catherine Packer, Mercy Buluzi, Elise Healy, Bagrey Ngwira
Publication date: April, 2018

Journal article Link to Journal Article

Observational study of the acceptability of Sayana® Press among intramuscular DMPA users in Uganda and Senegal

This study measured acceptability of DMPA-SC (Sayana® Press) among intramuscular DMPA (DMPA-IM) users. Current DMPA-IM users in Senegal and Uganda accepted DMPA-SC, and most preferred DMPA-SC over DMPA-IM. DMPA-SC can be safely introduced into family planning programs and administered by trained community health workers, with expectation of client uptake.

Contraception. 2014. May;89(5):361-7. Epub 2014 Feb 6. https://doi.org/10.1016/j.contraception.2014.01.022

 

 

Institutional author(s): FHI 360
Individual author(s): Holly M Burke, Monique P. Mueller, Brian Perry, Catherine Packer, Leonard Bufumbo, Daouda Mbengue, Ibrahima Mall, Bocar Mamadou Daff, Anthony K Mbonye
Publication date: February, 2014

Journal article Observational study of the acceptability of Sayana® Press among intramuscular DMPA users in Uganda and Senegal

Provider acceptability of Sayana® Press: results from community health workers and clinic-based providers in Uganda and Senegal.

Sayana® Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) in Uniject™, has potential to be a valuable innovation in family planning (FP) because it may overcome logistic and safety challenges in delivering intramuscular DMPA (DMPA IM). However, SP’s acceptability is unknown. We measured acceptability of SP among clinic-based providers (Senegal only) and community health workers. This open-label observational study was conducted in clinics in three districts in Senegal and community-based services in two districts in Uganda. Providers administered SP to clients seeking reinjection of DMPA IM. We conducted in-depth interviews with 86 providers (52 in Senegal, 34 in Uganda) to assess their experiences providing SP to clients.

Institutional author(s): FHI 360, Centre de Formation et de Recherche en Santé de la Reproduction (CEFOREP), Senegal Ministry of Health and Social Action, Uganda Ministry of Health
Individual author(s): Holly M Burke, Monique P. Mueller, Catherine Packer, Brian Perry, Leonard Bufumbo, Daouda Mbengue, Bocar Mamadou Daff, Anthony K Mbonye
Publication date: January, 2014

Journal article Link to Journal Article