FHI 360, Durham, NC, USA.
College of Medicine, University of Malawi, Blantyre, Malawi.
Glob Health Sci Pract. 2019 Mar 29;7(1):54-65. doi: 10.9745/GHSP-D-18-00433. Print 2019 Mar 22.
To assess the supply- and demand-side factors influencing continued use of the injectable contraceptive subcutaneous depot medroxyprogesterone acetate (DMPA-SC).
We conducted a 12-month randomized controlled trial in Malawi to measure DMPA-SC continuation rates. A total of 731 women presenting to clinic-based providers (CBPs) at 6 Ministry of Health clinics or to community health workers (CHWs) in rural communities were randomized to receive DMPA-SC administered by a provider or be trained to self-inject DMPA-SC. Data collectors contacted women after the reinjection window at 3, 6, and 9 months to collect data on discontinuation and women's experiences. Twelve months after enrollment or at early discontinuation, women had their final interview, including pregnancy testing. We compared continuation, pregnancy, and safety by whether DMPA-SC or self-injection training was provided by CHWs versus CBPs. We also conducted an exploratory analysis assessing the association between women's sociodemographic factors and the risk for discontinuation using stratified Cox proportional hazards models.
The type of provider did not seem to influence continuation, pregnancy, or safety. As reported previously, women in the self-injection group were significantly less likely to discontinue the method compared with women in the provider-administered group (hazard ratio, 0.43; <.001). The risk for discontinuation was also different among health facility catchment sites (<.001). No other assessed sociodemographic factors were found to significantly influence the risk for discontinuation.
Public-sector CHWs can safely and effectively provide DMPA-SC and train women to self-inject DMPA-SC in low-resource settings. DMPA-SC continuation did not seem to be influenced by the type of provider, whether CBP or CHW, or women's sociodemographic characteristics.
评估影响皮下注射长效醋酸甲羟孕酮（DMPA-SC）续用的供给侧和需求侧因素。
我们在马拉维开展了一项为期 12 个月的随机对照试验，以测量 DMPA-SC 的续用率。共有 731 名妇女在 6 家卫生部诊所的基于诊所的提供者（CBP）或在农村社区的社区卫生工作者（CHW）处就诊，随机分配接受由提供者给予的 DMPA-SC 或接受自我注射 DMPA-SC 的培训。数据收集员在重新注射窗口期后 3、6 和 9 个月联系妇女，收集有关停药和妇女经历的数据。在入组后 12 个月或提前停药时，妇女进行了最后一次访谈，包括妊娠检测。我们比较了 DMPA-SC 或自我注射培训由 CHW 与 CBP 提供时的续用、妊娠和安全性。我们还进行了一项探索性分析，使用分层 Cox 比例风险模型评估妇女的社会人口统计学因素与停药风险之间的关联。
提供者的类型似乎并未影响续用、妊娠或安全性。如前所述，与接受提供者管理组的妇女相比，自我注射组的妇女显著不太可能停止使用该方法（危险比，0.43；<0.001）。卫生机构服务范围内的地点也存在不同的停药风险（<0.001）。未发现其他评估的社会人口统计学因素显著影响停药风险。
公共部门的 CHW 可以在资源匮乏的环境中安全有效地提供 DMPA-SC，并培训妇女自我注射 DMPA-SC。DMPA-SC 的续用似乎不受提供者类型（CBP 或 CHW）或妇女社会人口统计学特征的影响。
