DMPA-SC: an emerging option to increase women's contraceptive choices

Askew, Ian; Wells, Elisa

doi:10.1016/j.contraception.2018.08.009

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…Within the group of DMPA injectables, women have three options: 1) DMPA-SC self-injection (SI), 2) DMPA-SC provider-administered (PA); or 3) DMPA-IM, which is not designed for self-administration. As a contraceptive self-care method [4], DMPA-SC has the potential to reduce barriers to contraceptive use, particularly in settings with limited health workforce and for populations for whom repeated facilitybased care-seeking is otherwise challenging or undesirable, including those facing stigma or who wish to use a contraceptive method covertly [5]. One feature that makes DMPA-SC SI unique among its DMPA alternatives is the exibility for users to inject themselves outside of the health facility setting.…”

Section: Introductionmentioning

confidence: 99%

Acceptability and effectiveness of empathy-based provider training and community-level awareness activities on self-injectable contraceptive use in Niger, Lagos, and Oyo States, Nigeria: A mixed methods program evaluation

Ontiri,

Rothschild,

Tariq

et al. 2024

Preprint

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Background: Interventions aimed to increase healthcare provider empathy and capacity to deliver person-centered care have been shown to improve healthcare seeking and outcomes. In the context of self-injectable contraceptive service delivery, empathetic counseling and hands-on coaching are promising approaches for addressing “fear of the needle” among clients interested in using subcutaneous depot medroxyprogesterone (DMPA-SC). In Nigeria, the Delivering Innovation for Self-Care (DISC) project developed and evaluated an empathy-based in-service training and supportive supervision intervention for public sector family planning providers, which was implemented in conjunction with community-based sensitization. Methods: The DISC intervention was evaluated using a quasi-experimental mixed methods design. Effectiveness of the intervention on DMPA-SC service delivery, including DMPA-SC self-injection (SI) and provider administration (PA), was assessed using a single-group interrupted time series design that leveraged phased implementation in 36 study facilities. Service delivery data were extracted from the Nigerian Health Information System for the pre-intervention period and using program monitoring tools for the intervention and post-intervention maintenance period. Outcomes were modeled using linear generalized estimating equations. In-depth interviews were conducted with trained providers. Results: Mean DMPA-SC service provision increased by 28 (95% confidence interval [CI] 18.0-38.3) visits on average per facility in the first month of implementation, relative to a pre-intervention data strengthening phase. The intervention was associated with an increase in mean facility-level DMPA-SC SI service delivery of 25.6 visits (95% CI 15.3-35.4). The intervention was associated with overall increases in FP service delivery. Trained providers reported substantial increases in client demand for DMPA-SC SI, coupled by increased provider feelings of confidence and capacity to counsel and train clients to self-inject. While providers indicated that stockouts of intramuscular DMPA (DMPA-IM) resulted in shifts towards DMPA-SC, we did not observe group-level decreases in DMPA-IM or long-acting reversible contraception provision. Increases in DMPA-SC service provision were sustained in the post-intervention maintenance period. Discussion: Our findings demonstrate the effectiveness and acceptability of project implementing combined supply-and demand-side interventions aimed at expanding awareness and access to self-injectable contraception in Nigeria. In this context, family planning providers highly valued in-service training and ongoing support that built capacity for empathetic client engagement.

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Section: Introductionmentioning

confidence: 99%

Acceptability and effectiveness of empathy-based provider training and community-level awareness activities on self-injectable contraceptive use in Niger, Lagos, and Oyo States, Nigeria: A mixed methods program evaluation

Ontiri,

Rothschild,

Tariq

et al. 2024

Preprint

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“…Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a newly introduced injectable contraceptive, first approved in 2015 and now registered in over 33 countries [3] , [4] . Its design that combines the drug and needle in a prefilled system makes it simple to administer hence providing users with the option to self-inject as well as facilitating task-sharing to other cadres such as community health workers [3] , [5] . There is evidence of demonstrated high levels of acceptability and method satisfaction among DMPA-SC users [6] , [7] .…”

Section: Introductionmentioning

confidence: 99%

Missed opportunity for self-injectable contraception awareness and adoption: Insights from client exit interviews in Uganda and Nigeria

Ontiri,

Rothschild,

Nakimuli

et al. 2023

Contraception: X

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“…However, there are challenges in rolling out this new efficacious intervention, and major implementation problems have been encountered during scale-up [ 8 – 13 ]. One challenge is identifying the barriers that prevent effective implementation and strategies to mitigate these problems [ 14 ]. Furthermore, many of these interventions are described in the grey literature and are not published in peer-reviewed journals, of which systematic reviews have been conducted.…”

Section: Introductionmentioning

confidence: 99%

Implementation strategies to scale up self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception: a scoping review

2023

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Background Self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) is registered in many countries. It shows great potential for improving contraceptive access, continuation, and autonomy. However, there are challenges in rolling out this new efficacious intervention, and major implementation problems have been encountered during scale-up. Objective To describe the implementation strategies to scale up self-administered DMPA-SC and the barriers, facilitators, and outcomes of these programs. Method Recent guidelines, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, were used to design and report this review. An article or report was eligible for inclusion if it reported interventions that could scale up self-administered DMPA-SC implementation or its facilitators, barriers, or outcomes. We searched six electronic databases and the grey literature for eligible articles and reports. Two reviewers independently screened the document titles, abstracts, and full texts to identify eligible documents. Data were extracted using structured forms. Using the Effective Practice and Organization of Care (EPOC) taxonomy of health systems framework for thematic analysis, data were presented in a narrative approach. Results Of the 755 retrieved documents, 34 were included in this review. Most of the documents included were multi-country reports (n = 14), and all documents were published within the last 5 years (2018–2021). This review identified documents that reported interventions in all EPOC domains. The most-reported interventions were: task-sharing amongst health workforce cadres, engaged leadership, encouraging policies, training and education, DMPA-SC demand generation, integration into existing programs, improved funding mechanisms, collaboration with development partners, and supply chain strengthening. The main barriers were suboptimal funding, inadequate human resources, and poor logistics supply of DMPA-SC. There was minimal evidence of scale-up outcomes. Conclusion This scoping review reported a wide range of interventions employed by countries and programs to scale up DMPA-SC self-administration but minimal evidence of the scale-up outcomes. Evidence from this review can help design better programs that improves access to quality family planning services to achieve the Sustainable Development Goals (SDG) targets 3.7. However, efforts should focus on rigorous implementation research that assess scaled up self-administered DMPA-SC interventions and report their outcomes. Registration The protocol for this review was registered in the protocols.io repository (https://www.protocols.io/view/a-protocol-for-a-scoping-review-of-implementation-x54v9yemmg3e/v1).

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DMPA-SC: an emerging option to increase women's contraceptive choices

Cited by 10 publications

References 23 publications

Acceptability and effectiveness of empathy-based provider training and community-level awareness activities on self-injectable contraceptive use in Niger, Lagos, and Oyo States, Nigeria: A mixed methods program evaluation

Acceptability and effectiveness of empathy-based provider training and community-level awareness activities on self-injectable contraceptive use in Niger, Lagos, and Oyo States, Nigeria: A mixed methods program evaluation

Missed opportunity for self-injectable contraception awareness and adoption: Insights from client exit interviews in Uganda and Nigeria

Implementation strategies to scale up self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception: a scoping review

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