Evaluation of telemedicine medical abortion using a no‐test protocol in the Eastern Europe and Central Asian region: Evidence from Ukraine, Uzbekistan, and Azerbaijan

Abstract

ObjectiveTo evaluate safety, feasibility, and acceptability of a telemedicine medical abortion service without pre‐treatment in‐person tests in Ukraine, Uzbekistan, and Azerbaijan.MethodsWe conducted an open‐label, prospective, observational clinical study at five clinics in the three countries. Interested and eligible participants scheduled a telemedicine consultation with a study provider by phone or video. Medical abortion pills could be obtained by mail or courier or picked up at the study clinic or a pharmacy. Study providers contacted participants 1 week after mifepristone ingestion to assess abortion outcomes based on symptoms, and 3 weeks later to review the result of an at‐home, high‐sensitivity, urine pregnancy test. Participants were referred to in‐person visit based on symptoms, urine pregnancy test results, or initiative by the participant.ResultsIn all, 300 women participated in the study. Almost all participants received medical abortion medications the same day as their first contact with the study clinic, and the majority (n = 297, 99.0%) did not experience any problems receiving them. All except two women (0.67%) followed provider instructions on administration of medications. The majority of participants had a complete abortion without a procedure (Ukraine: n = 115, 95.8%; Uzbekistan: n = 127, 97.7%; Azerbaijan: n = 49, 98.0%), few had in‐person visits (Ukraine: n = 30, 25.0%; Uzbekistan: n = 3, 2.3%; Azerbaijan: n = 4, 8.0%), and most were very satisfied or satisfied with the service (Ukraine: n = 116, 96%; Uzbekistan: n = 128, 98%; Azerbaijan: n = 45, 90%). No serious adverse events occurred.ConclusionTelemedicine medical abortion using the no‐test protocol is safe, feasible and acceptable for women in Ukraine, Uzbekistan, and Azerbaijan.