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Tag: continuation


DMPA-SC self-injection: Advancing contraceptive access and use for women and girls

This DMPA-SC Advocacy Pack brief details the strong body of evidence and experience with self-injection of DMPA-SC, including how the practice can reduce access-related barriers, improve contraceptive continuation, and enhance women’s autonomy.

Institutional author(s): PATH, Clinton Health Access Initiative (CHAI), inSupply Health, Jhpiego, JSI
Publication date: 2023

Evidence at-a-glance: What we know about DMPA-SC, a novel injectable contraceptive

These DMPA-SC Advocacy Pack briefs outline existing evidence on DMPA-SC grouped into top-line messages featuring data from different countries. Several “spotlight” handouts on specific topics can be paired with the summary brief as needed. All handouts can be printed and distributed directly to decision-makers.

Institutional author(s): PATH
Publication date: 2023

Resources: A list of references about subcutaneous DMPA

This brief lists key references and resources from the evidence base on DMPA-SC. Pair this with the Evidence at-a-glance brief if your target decision-maker would like to have access to the data in that handout.

Institutional author(s): PATH
Publication date: October, 2019

Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda

Quality of family planning counseling is likely associated with whether or not women continue to use the same contraceptive method over time. The Method Information Index (MII) is a widely available measure of contraceptive counseling quality but little is known about its association with rates of method continuation. Using data from a prospective cohort study of 1,998 social franchise clients in Pakistan and Uganda, we investigated the relationship between reported baseline MII and the risk of method continuation over 12 months using survival analysis and Cox proportional hazard models. Higher scores on the 3-question Method Information Index (MII)—measuring client-reported receipt of contraceptive information—was associated with continued use of family planning over 12 months. We recommend incorporating use of the MII in routine assessments of family planning service quality.

Global Health: Science and Practice. March 2019, 7(1):87-102. https://doi.org/10.9745/GHSP-D-18-00407

 

Institutional author(s): Metrics for Management, Population Council, Wilfrid Laurier University, Population Services International (PSI), MSI Reproductive Choices, Makerere University
Individual author(s): Nirali M. Chakraborty, Karen Chang, Benjamin Bellows, Karen A. Grépin, Waqas Hameed, Amanda Kalamar, Xaher Gul, Lynn Atuyambe, Dominic Montagu
Publication date: March, 2019

Journal article Association Between the Quality of Contraceptive Counseling and Method Continuation: Findings From a Prospective Cohort Study in Social Franchise Clinics in Pakistan and Uganda

Continuation of self-injected versus provider-administered contraception in Senegal: a nonrandomized, prospective cohort study

Objectives: The primary objective of this study was to compare the 12-month continuation rate for women who self-injected subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) with that for women receiving intramuscular depot-medroxyprogesterone acetate (DMPA-IM) from a provider. This research contributes to the broader goal of identifying solutions to support women to use contraception for their full desired duration.
Study design: Participants were clients from 13 clinics in the Dakar and Thiés regions of Senegal who had decided to use injectable contraception prior to enrollment. They chose self-injection of DMPA-SC or provider administration of DMPA-IM. Self-injectors were trained and given three units of DMPA-SC. The provider-injected group received DMPA-IM and returned to the clinics for future injections. We interviewed participants at baseline and after the second, third and fourth injections (the equivalent of 12 months of contraceptive coverage). We employed Kaplan–Meier methods to estimate continuation probabilities, with a log-rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation.
Results: The 12-month continuation rate for 650 women self-injecting DMPA-SC was 80.2%, while that for 649 women receiving DMPA-IM from a provider was 70.4% (p<.01). The difference in continuation between self-injectors and those receiving DMPA from a provider remained significant in a multivariate Cox regression model. The primary reason for discontinuation in both groups (44.7% self-injected; 44.5% provider-injected) was forgetting to reinject or reinjecting late. Fewer women reported side effects in the self-injection group than in the provider-administered group.
Conclusions: The higher 12-month continuation rate for women self-injecting DMPA-SC relative to provider-administered DMPA-IM suggests that self-injection may help prevent pregnancy more consistently and continuously.

Institutional author(s): PATH, Ministère de la Santé et de l'Action Sociale Senegal
Individual author(s): Jane Cover, Maymouna Ba, Jennifer Kidwell Drake, Marėme Dia NDiaye
Publication date: November, 2018

Journal article Link to Journal Article

Continuation of subcutaneous or intramuscular injectable contraception when administered by facility-based and community health workers: findings from a prospective cohort study in Burkina Faso and Uganda

The aim of this study was to examine continuation of subcutaneous and intramuscular depot medroxyprogesterone acetate (DMPA-SC and DMPA-IM) when administered by facility-based health workers in Burkina Faso and Village Health Teams (VHTs) in Uganda. Participants were family planning clients of health centers (Burkina Faso) or VHTs (Uganda) who had decided to initiate injectable use. Women selected DMPA-SC or DMPA-IM and study staff followed them for up to four injections (providing 12 months of pregnancy protection) to determine contraceptive continuation. Study staff interviewed women at their first injection (baseline), second injection, fourth injection and if they discontinued either product.

Institutional author(s): PATH, Makerere University, Institut Africain de Santé Publique (IASP), Institut Supérieur des Sciences de la Population, Centre MURAZ, FHI 360, Institut de Recherche en Sciences de la Santé (IRSS)
Individual author(s): Ellen MacLachlan, Lynn Atuyambe, Tieba Millogo, Georges Guiella, Seydou Yaro, Simon Kasasa, Justine Bukenya, Agnes Nyabigambo, Fredrick Mubiru, Justine Tumusiime, Yentéma Onadja, Lonkila Moussa Zan, Clarisse Goeum/Sanon, Seni Kouanda, Allen Namagembe
Publication date: August, 2018

Journal article Link to Journal Article

DMPA-SC self-injection supports women to use injectable contraception longer

This research brief describes research findings that women who self-inject DMPA-SC continue to use contraception longer than women who use intramuscular DMPA (DMPA-IM) administered by a health worker.

Institutional author(s): PATH
Publication date: July, 2018

Brief DMPA-SC self-injection supports women to use injectable contraception longer

Predictors of DMPA-SC continuation among urban Nigerian women: the influence of counseling quality and side effects

In 2015, private healthcare providers in Nigeria introduced DMPA-SC (depot medroxyprogesterone acetate administered subcutaneously) into the method mix. We aimed to [1] examine the sociodemographic predictors of continued DMPA-SC use after 3 months, and [2] characterize the additional influences of contraceptive counseling quality and experiences of side effects on continuation. From March to August, 2016, we conducted phone interviews with a convenience sample of women obtaining DMPA-SC from selected providers to survey them about their experience obtaining an initial dose of DMPA-SC. Study coordinators contacted women again about 3 months later after when they were due for reinjection. We used logistic regressions to examine the likelihood of having obtained a subsequent dose of DMPA-SC at follow-up as predicted by sociodemographic characteristics, a quality of counseling indicator based on responses to a 14-item scale, and reports of side effects experienced.

Institutional author(s): University of California San Francisco
Individual author(s): Jenny Liu, Jennifer Shen, Nadia Diamond-Smith
Publication date: May, 2018

Journal article Link to Journal Article

Continuation of injectable contraception when self-injected vs. administered by a facility-based health worker: a nonrandomized, prospective cohort study in Uganda

The purpose of this study was to compare 12-month continuation rates for subcutaneous depot medroxyprogesterone acetate (DMPA-SC) administered via self-injection and DMPA-IM administered by a health worker in Uganda. Women seeking injectable contraception at participating health facilities were offered the choice of self-injecting DMPA-SC or receiving an injection of DMPA-IM from a health worker. Those opting for self-injection were trained one-on-one. They self-injected under supervision and took home three units, a client instruction guide and a reinjection calendar. Those opting for DMPA-IM received an injection and an appointment card for the next facility visit in 3 months. We interviewed participants at baseline (first injection) and after 3 (second injection), 6 (third injection) and 9 (fourth injection) months, or upon discontinuation. We used Kaplan–Meier methods to estimate continuation probabilities, with a log-rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation.

Institutional author(s): PATH, Uganda Ministry of Health
Individual author(s): Jane Cover, Allen Namagembe, Justine Tumusiime, Damalie Nsangi, Jeanette Lim, Dinah Nakiganda-Busiku
Publication date: April, 2018

Journal article Link to Journal Article

Effect of self-administration versus provider-administered injection of subcutaneous depot medroxyprogesterone acetate on continuation rates in Malawi: a randomised controlled trial

Injectable contraceptives are popular in sub-Saharan Africa but have high discontinuation rates due partly to the need for provider-administered re-injection. We compared continuation rates of women who self-injected subcutaneous depot medroxyprogesterone acetate (DMPA-SC) and women who received DMPA-SC from a health-care provider, including community health workers (CHWs).We did an open-label randomised controlled trial based at six Ministry of Health clinics in rural Mangochi District, Malawi. Health-care providers recruited adult women who presented at the six clinics or to CHWs in rural communities in the clinic catchment areas. Participants received DMPA-SC and were randomised (1:1) to receive provider-administered injections or training in how to self-inject DMPA-SC. Randomisation was done via a computer-generated block randomisation schedule with block sizes of four, six, and eight and stratified by study site, generated by an independent statistician. Self-injectors administered the first injection under observation and were sent home with three doses, written instructions, and a calendar. The provider-administered group received a DMPA-SC injection and a calendar, and were asked to return for subsequent injections. Data collectors contacted participants after the 14-week re-injection window at 3, 6, and 9 months to collect continuation data. At 12 months after enrolment or early discontinuation, women had their final interview, which included pregnancy testing. The primary outcome was discontinuation of DMPA-SC, as assessed in the intention-to-treat population. We used Kaplan-Meier methods to estimate the probabilities of continuation and a log-rank test to compare groups. Safety was assessed in the as-treated population, which consisted only of participants who successfully received at least one DMPA-SC injection after randomisation. This trial is registered with ClinicalTrials.gov, number NCT02293694.This study lasted from Sept 17, 2015, to Feb 21, 2017. 731 women underwent randomisation, with 364 assigned to the self-administered group and 367 to the provider-administered group. One woman in the self-injection group withdrew at month 0. Treatment was discontinued by 99 women in the self-administered group and 199 women in the provider-administered group. The 12 month continuation rate was 73% in the self-injection group and 45% in the provider-administered group, giving an incidence rate ratio of 0·40 (95% CI 0·31–0·51; p<0·0001). Adverse events deemed to potentially be treatment-related were reported by ten women (20 events) in the self-administered group and 17 women (28 events) in the provider-administered group. Five serious adverse events were reported during the trial by four women; two events related to DMPA-SC (menorrhagia and anemia requiring hospital admission) were reported by the same woman in the provider-administered group and resolved without sequelae. The other serious adverse events, including one death, were deemed to be unrelated to DMPA-SC. Women who self-injected DMPA-SC had significantly higher rates of continuation than those receiving provider-injected DMPA-SC. Community-based provision of injectable contraception for self-injection in low-resource settings seems to be safe and feasible. Self-administration of DMPA-SC should be made widely available.

Institutional author(s): FHI 360
Individual author(s): Holly M Burke, Mario Chen, Mercy Buluzi, Rachael Fuchs, Silver Wevill, Lalitha Venkatasubramanian, Leila Dal Santo
Publication date: March, 2018

Journal article Website Link