An observational study to test the acceptability and feasibility of using medical and nursing students to instruct clients in DMPA-SC self-injection at the community level in Kinshasa

Abstract

ObjectivesGiven the promise of DMPA-SC to increase community-level access to modern contraception in developing countries, we conducted an observational study to assess the acceptability and feasibility of DMPA-SC self-injection among women in Kinshasa, Democratic Republic of the Congo, and of medical/nursing (M/N) students as instructors for self-injection.Study designWomen who selected DMPA-SC at a community outreach event adjacent to a health center were interviewed upon acceptance (baseline) and then 3, 6 and 12 months later.ResultsOf 850 clients selecting DMPA-SC at baseline, 640 (75.3%) opted for self-injection over being injected by the M/N students for reasons of convenience and personal agency. Among these 640 self-injectors, 47.5% were anxious at baseline (for fear of needles or injecting incorrectly). Over 80% reported feeling very ready after training, confident that they knew how to self-inject and confident that they would remember the next injection date. By 3 months, 97% described it as easy. Half (54%) experienced side effects, mainly menstrual irregularities, the main reason for discontinuation. At 6-month follow-up, self-injectors cited effectiveness and ease of use as positive elements, though one quarter reported side effects. Their impressions of M/N students as instructors were highly positive.ConclusionsWhere DMPA-SC was free and easily accessible, the majority of women interested in DMPA-SC opted to learn self-injection. The M/N students performed well in instructing women to self-inject. Clients were highly satisfied with the services received, yet many did not recognize their student status, possibly because outreach occurred near a health facility. Once told, clients remained very favorable, suggesting strong motivation to receive their preferred contraceptive free, whoever the provider.Implication statementThis study provides additional evidence on the acceptability and the feasibility of the self-injection of DMPA-SC by users from a resource-limited setting.

Feasibility and acceptability of using medical and nursing students to provide Implanon NXT at the community level in Kinshasa, Democratic Republic of Congo

“…The findings of this paper also showed that using M/N students as community-based providers was entirely acceptable to FP users in Kinshasa, who generally gave positive evaluations of the services they received. This is consistent with findings from piloting of communitybased provision of DMPA-SC [10,23] in Kinshasa, and similar studies indicating that community-health workers could successfully be used to increase access to contraceptives throughout Sub-Saharan Africa [1,2].…”

Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi: implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

“…Our findings are similar to and contribute to the growing literature about DMPA-SC disposal [38]. Limited published literature exists related to storage and disposal of DMPA-SC, and almost all has been in the context of self-injection offered within research contexts, including Malawi [19,22], Senegal [39], Uganda [30], and the Democratic Republic of the Congo [40]. This is the first study to report on the waste management experiences of adolescent and covert self-injectors within the context of program scale up-important populations expected to especially benefit from self-injection.…”

Introduction of Community-Based Provision of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in Benin: Programmatic Results

“…Recent studies have shown that CHWs can safely and acceptably administer DMPA-SC in communities 8 – 10 . Studies have also shown that women can be trained to self-inject, where the practice is permitted and the product is registered as a self-injectable, which allows greater contraceptive control over their fertility 11 , 12 …”