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

Abstract

Background: The use of implants has steadily increased in Kinshasa since 2013 but clinic-based access to this family planning method is limited due to distance and costs barriers. The objective of this study was to examine the feasibility and acceptability of providing Implanon NXT at the community level using medical and nursing students (M/N) as distributors, as part of a strategy to improve contraceptive uptake in the Democratic Republic of Congo. Methods: A cohort of 531 women who chose to receive Implanon NXT from a M/N student during community-based campaign days participated in three rounds of a quantitative survey administered at the time of insertion of the method, and at 6 and 12 months later. We conducted descriptive analysis to assess the feasibility and acceptability of providing the method through M/N students in terms of method choice, user profiles, contraceptive history, experience with insertion and side effects, continuation / discontinuation of the method, and overall satisfaction with FP services as well as students' preparedness and capacity to safely offer the method, and their satisfaction with the experience.. Results: The study demonstrated the feasibility of training students for community-based provision of Implanon NXT and 95% of them were satisfied with their experience. Acceptability of both the method and the service delivery strategy was high among participants, including among young and first-time contraceptive users. Out of the 441 women with a known outcome at 12 months, 92% still had Implanon NXT inserted, despite some of them reporting experiencing side effects. The vast majority (79%) would "strongly recommend" obtaining NXT from a M/N student if a friend wanted to avoid pregnancies. Conclusions: The provision of Implanon NXT at the community-level is a promising solution to address some of the barriers to accessing this method for women living in Kinshasa. However, strengthening pre-insertion counseling, particularly on expected side-effects and the possibility of early removal, is necessary to increase informed choice for the women and potentially limit method discontinuation.

Heterogeneity of Modern Contraceptive Use among Urban Slum and Nonslum Women in Kinshasa, DR Congo: Cross-Sectional Analysis

“…These interventions used nursing students as young ambassadors to provide contraceptive counseling and a range of contraceptive methods at the community level. These services offered intramuscular injectables and implants, and trained interested clients to subcutaneously self-inject contraceptives [28][29][30]. As shown in our results, a higher percentage of slum residents reported having received FP services from CHWs than that of nonslum residents.…”

Ensuring sufficient service capacity for removals of long-acting reversible contraceptives: a mixed-method study of provider experiences in Senegal

“…To our knowledge, few studies capture provider experiences providing implant and IUD insertions and removals in sub-Saharan African settings. Available evidence includes a study of medical and nursing students’ self-assessments of their ability to provide implants at the community level in the Democratic Republic of Congo 9 and qualitative studies documenting insufficient training, lack of equipment and time, and unclear referral pathways for difficult removals as barriers to providing implant removals in Botswana 13 , lack of experience and lack of refresher trainings as barriers to inserting IUDs cited by midwives in Ghana 18 , and insufficient space to provide IUDs mentioned by providers and stakeholders in Ethiopia 17 . None of these studies offer a side-to-side comparison of provider experiences with implant and IUD removals.…”

“…Clinical challenges are closely related to programmatic challenges associated with scaling-up the availability of both implant insertion and removal services: providing sufficient training to health care providers, including in difficult removal techniques such that providers are confident in their removal skills; ensuring that appropriate equipment and supplies are available for both routine and difficult removals; and establishing necessary referral mechanisms as needed, including for difficult removals or where providers may insert but not remove implants 5,7 . A few recent studies which document the client perspective in relation to implant removals in sub-Saharan Africa reiterate these challenges [8][9][10][11][12][13] .…”

Task-shifting and family planning continuation: contraceptive trajectories of women who received their method at a community-based event in Kinshasa, DRC

“…In response to these issues, community-based programs have been implemented, re ned and scaled-up in the DRC since it became a focus country for the FP2020 initiative [9]. After piloting the provision of new contraceptive technologies (including DMPA-SC and Implanon NXT) as community methods [10,11], the DRC also developed an innovative service delivery model using 3rd and 4th year Nursing School (NS) students to provide FP services during large community campaigns as part of their practicum training [12]. Under this model, NS students participate in three to four campaigns per year in the 93 health zones and seven provinces where the model is currently implemented.…”