Burke Holly M, Mueller Monique P, Perry Brian, Packer Catherine, Bufumbo Leonard, Mbengue Daouda, Mall Ibrahima, Daff Bocar Mamadou, Mbonye Anthony K
FHI 360, Durham, NC, USA.
FHI 360, Durham, NC, USA.
Contraception. 2014 May;89(5):361-7. doi: 10.1016/j.contraception.2014.01.022. Epub 2014 Feb 6.
Sayana® Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) in Uniject™, has potential to be a valuable innovation in family planning (FP) because it may overcome logistic and safety challenges in delivering intramuscular DMPA (DMPA IM). However, SP's acceptability is unknown. We measured acceptability of SP among DMPA IM users.
This open-label observational study was conducted in clinics in three districts in Senegal and community-based distribution services in two districts in Uganda. Experienced DMPA IM users were offered SP by community health workers (CHWs) or clinic-based providers. SP decliners were asked to discuss their reasons. Those who received SP were interviewed pre- and postinjection and 3 months later, when they were asked if they would select SP over DMPA IM if it were available.
One hundred twenty women in Uganda and 242 in Senegal received SP (117 and 240 were followed up, respectively). Nine Ugandan and seven Senegalese SP decliners were interviewed. Three months after receiving SP, 84% [95% confidence interval (CI)=75%-93%] of Ugandan participants and 80% (95% CI=74%-87%) of Senegalese participants said they would select SP over DMPA IM. Main reasons for selecting SP were fewer side effects, liking the method, fast administration, less pain and method effectiveness. Thirty-four adverse events were reported but were not serious. No pregnancies were reported.
Current DMPA IM users in Senegal and Uganda accepted SP, and most preferred SP over DMPA IM. SP can be safely introduced into FP programs and administered by trained CHWs, with expectation of client uptake.
We found SP acceptable and safe in diverse settings among current intramuscular DMPA users, including those who received SP from CHWs. This provides evidence that SP would be used and could therefore reduce unmet family planning needs if introduced into family planning programs.
Sayana® Press（SP）是一种醋酸甲羟孕酮长效注射剂的皮下注射剂型，采用Uniject™装置，它有可能成为计划生育领域一项有价值的创新，因为它可能克服肌肉注射醋酸甲羟孕酮（DMPA IM）在后勤保障和安全性方面的挑战。然而，SP的可接受性尚不清楚。我们对使用DMPA IM的人群中SP的可接受性进行了评估。
这项开放标签观察性研究在塞内加尔三个地区的诊所以及乌干达两个地区的社区分发服务点开展。经验丰富的DMPA IM使用者由社区卫生工作者（CHW）或诊所工作人员提供SP。拒绝使用SP的人被要求说明原因。接受SP的人在注射前后以及3个月后接受访谈，询问他们如果有选择的话是否会选择SP而非DMPA IM。
乌干达有120名女性和塞内加尔有242名女性接受了SP（分别对117名和240名进行了随访）。对9名拒绝使用SP的乌干达人和7名拒绝使用SP的塞内加尔人进行了访谈。接受SP三个月后，84%[95%置信区间（CI）=75%-93%]的乌干达参与者和80%（95%CI=74%-87%）的塞内加尔参与者表示他们会选择SP而非DMPA IM。选择SP的主要原因是副作用更少、喜欢这种方法、给药速度快、疼痛轻以及方法有效。报告了34起不良事件，但均不严重。未报告妊娠情况。
塞内加尔和乌干达目前使用DMPA IM的人群接受了SP，并且大多数人比起DMPA IM更喜欢SP。SP可以安全地引入计划生育项目，并由经过培训的社区卫生工作者进行给药，有望被客户接受。
我们发现在包括从社区卫生工作者处接受SP的人群在内的当前肌肉注射DMPA的不同使用者中，SP是可接受且安全的。这为以下观点提供了证据：如果引入计划生育项目，SP将会被使用，因此可以减少未满足的计划生育需求。
