Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception

Chin-Quee, Dawn S.; Bratt, John H.; Malkin, Morrisa; Nduna, Mavis Mwale; Otterness, Conrad; Jumbe, Lydia; Mbewe, Reuben

doi:10.9745/ghsp-d-13-00025

Cited by 34 publications

(54 citation statements)

References 4 publications

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“…Furthermore, although community-based provision of injectables by CHWs is a safe, acceptable, and effective way to increase access to family planning in LMICs, studies of such interventions in Kenya and Zambia found relatively high 12 month discontinuation rates of 32% and 37%, respectively. [12][13][14] A 2013 Cochrane review of interventions to increase continuation rates of hormonal methods of contraception 15 identified only one study with a positive effect on continuation; however, the evidence for this intensive counselling intervention, which provided women with audiovisual messaging at each follow-up visit, was categorised as "low grade". 15 Another study identified in that review examining the role of counselling on oral contraceptive continuation found an effect only when counselling was coupled with phone calls.…”

Section: Implications Of All the Available Evidencementioning

confidence: 99%

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

Burke

Chen

Buluzi

et al. 2018

The Lancet Global Health

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Section: Implications Of All the Available Evidencementioning

confidence: 99%

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

Burke

Chen

Buluzi

et al. 2018

The Lancet Global Health

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“… 7–10 Based on the assumption that workers at the grassroots level are more accessible and acceptable to users in their communities, they are expected to improve access and coverage to basic health services. 9 11 …”

Section: Introductionmentioning

confidence: 99%

Between compliance and resistance: exploring discourses on family planning in Community Health Committees in Mozambique

et al. 2015

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ObjectivesAlthough the Mozambican government has implemented a community-based approach to family planning (FP), little is known about the appropriateness of this process. We explore how members of Community Health Committees (CHCs) address and act regarding FP.Methods/settingsAn in-depth qualitative study of CHCs was conducted at two sites in Maputo province—Ndlavela and Boane—using focus group discussions (n=6), informal conversations (n=4) and observation. The analysis followed a phenomenological approach.ResultsCHCs in Ndlavela appeared to transfer more of the expected information than those in Boane. However, in the CHCs at both study sites, we found heterogeneity in CHCs’ perspectives leading to conflicting views among committee members (CMs). Arising issues included contraceptive type, target groups, the desirable number of children per family as well as the way FP was to be represented. Moreover, weak communication between CMs and health workers, and lack of payment for CMs’ activities influenced promotion of FP.ConclusionsThe two CHCs framed FP in different ways leading to inconsistent participation of CHC members in promoting FP. Policymakers should consider the diversity of discourses and aspirations of these committees when delivering information to them.

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“…Women like the freedom from having to remember daily use and discretion afforded by injectable contraception . Providers also seem to prioritize injectables in some countries over other methods, because they require less frequent clinic visits and can be provided by less skilled service providers . Like preferences for injectable contraception, women in multiple settings have expressed preferences for an injectable PrEP product, which they perceived to last longer, require less medical intervention, have lower use burden and enable more discreet use .…”

Section: Discussionmentioning

confidence: 99%

Acceptability of a long‐acting injectable HIV prevention product among US and African women: findings from a phase 2 clinical Trial (HPTN 076)

Tolley

Zangeneh

et al. 2019

J Intern AIDS Soc

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IntroductionHigh HIV incidence and low adherence to daily oral PrEP among women underscore the need for more acceptable and easier to use HIV prevention products. Global demand for injectable contraception suggests that new, long‐acting, injectable formulations could meet this need. We examine acceptability of a long‐acting injectable PrEP among HIV‐uninfected women in Zimbabwe, South Africa and two United States phase 2 trial sites.MethodsQuantitative surveys were administered at the first, fourth and sixth injection visits. Focus group discussions (FGD) were conducted after the sixth injection visit. We compared the acceptability of injectable product attributes, prevention preferences and future interest in injectable PrEP by site and arm and ran longitudinal ordinal logistic regression models to identify determinants of future interest in injectable PrEP.ResultsBetween April 2015 and February 2017, the trial enrolled 136 (100 African, 36 US) women with a median age of 31 years. Most participants (>75%) rated injectable attributes as very acceptable. While few reported rash or other side effects, 56% to 67% reported injection pain, with nonsignificant differences over time and between arms. During FGDs, participants described initial fear of the injectable and variable experiences with pain. Most US and African participants preferred injectable PrEP to daily oral pills (56% to 96% vs. 4% to 25%). Future interest in using injectable PrEP was associated with acceptability of product attributes and was higher in African than US sites. In FGDs, participants described multiple reasons for trial participation, including a combination of monetary, health‐related and altruistic motivations. While associated with future interest in use in univariate models, neither altruistic nor personal motivations remained significant in the multivariate model.ConclusionsThis study found that long‐acting injectable PrEP is acceptable among African and US women experiencing product use. Acceptability of product attributes better predicted future interest in injectable use than experience of pain. This is reassuring as a single‐dose regimen of a different product has advanced to phase 3 trials. Finally, the study suggests that future demand for an injectable PrEP by women may be greater in African than US settings, where the risk of HIV is highest.

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Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception

Cited by 34 publications

References 4 publications

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

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

Between compliance and resistance: exploring discourses on family planning in Community Health Committees in Mozambique

Acceptability of a long‐acting injectable HIV prevention product among US and African women: findings from a phase 2 clinical Trial (HPTN 076)

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