Cover Jane, Ba Maymouna, Lim Jeanette, Drake Jennifer Kidwell, Daff Bocar M
PATH, PO Box 900922, Seattle, WA 98109, USA.
PATH, BP 15115, Dakar-Fann, Dakar, Senegal.
Contraception. 2017 Sep;96(3):203-210. doi: 10.1016/j.contraception.2017.06.010. Epub 2017 Jun 30.
Expanding contraceptive options through self-injection may improve access and confidentiality. There are few published studies on contraceptive self-injection in sub-Saharan Africa and none in West Africa, a region with high unmet need. This study was performed to assess feasibility of subcutaneous DMPA self-injection in Senegal; objectives were to (1) measure the proportion of participants who self-injected competently 3 months after training, (2) measure the proportion who self-injected on time (defined conservatively as within 7 days of reinjection date), and (3) assess acceptability of self-injection.
In this prospective cohort study, 378 women aged 18-49 years were trained to self-inject by study nurses. Three months later, women returned unprompted to the clinic to self-inject, and technique and visit timing were evaluated. Women continuing with a third self-injection were followed up at home after their next scheduled injection date. At each interaction, participants were interviewed to learn about their experience; additional questions during the final home visit focused on storage and disposal practices, and acceptability.
Among the 337 participants followed up 3 months post-training, 310 self-injected, and 87% did so competently. Factoring in women who declined to self-inject, electing to have the provider administer the injection instead, a total of 80% [95% confidence interval (CI)=75-84%] self-injected competently 3 months post-training, and 84% [95% CI=80-88%] reinjected on time, while 72% [95% CI=67-77%] were both on time and competent. The vast majority (93%) expressed a desire to continue.
Self-injection is feasible and acceptable among most study participants in Senegal.
These first research results on contraceptive self-injection in West Africa indicate initial feasibility and acceptability of the practice. Results underscore the importance of designing self-injection programs that empower and support women, including those with limited education.
通过自我注射来增加避孕方法的选择，可能会改善避孕服务的可及性和保密性。关于撒哈拉以南非洲地区避孕自我注射的已发表研究较少，而在未满足需求较高的西非地区则尚无相关研究。本研究旨在评估在塞内加尔进行皮下注射醋酸甲羟孕酮自我注射的可行性；目标是：（1）测量培训3个月后能熟练进行自我注射的参与者比例；（2）测量按时进行自我注射的比例（保守定义为在再次注射日期的7天内）；（3）评估自我注射的可接受性。
在这项前瞻性队列研究中，378名年龄在18 - 49岁的女性由研究护士培训进行自我注射。3个月后，女性自行返回诊所进行自我注射，并对注射技术和就诊时间进行评估。继续进行第三次自我注射的女性在下次预定注射日期后接受家访。在每次互动中，对参与者进行访谈以了解她们的经历；在最后一次家访中的其他问题集中在储存和处理方法以及可接受性方面。
在培训后3个月进行随访的337名参与者中，310名进行了自我注射，其中87%操作熟练。将拒绝自我注射而选择由医护人员进行注射的女性考虑在内，培训3个月后共有80%[95%置信区间（CI）=75 - 84%]的女性能够熟练自我注射，84%[95% CI = 80 - 88%]按时进行了再次注射，而72%[95% CI = 67 - 77%]既按时又操作熟练。绝大多数（93%）表示希望继续。
在塞内加尔的大多数研究参与者中，自我注射是可行且可接受的。
这些关于西非避孕自我注射的首批研究结果表明了该做法初步的可行性和可接受性。结果强调了设计能够赋予女性权力并为其提供支持的自我注射项目的重要性，包括那些受教育程度有限的女性。
