Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.
Curr Opin Obstet Gynecol. 2019 Dec;31(6):464-470. doi: 10.1097/GCO.0000000000000574.
Injectable contraception is a widely available and popular family planning method globally. It has evolved to allow for subcutaneous self-injection (DMPA-SC, Depo medroxyprogesterone acetate-subcutaneous). In this review, we will focus on research evaluating DMPA-SC, with specific regard to continuation rates, safety, and satisfaction among users.
Emerging evidence from the United States, Malawi, Uganda, and Senegal has established safety and higher continuation rates among self-inject users, compared with provider-inject users. Continuation is 10-28% higher among DMPA-SC self-inject users. Self-inject users across studies were highly satisfied and reported DMPA-SC was easy to use. Studies indicate continuation is likely to be attributable to self-administration and user autonomy, rather than inherent properties of the DMPA-SC injection.
DMPA-SC should be made available in high-resource and low-resource settings. Future efforts should be focused on implementation and evaluating how to best add DMPA-SC to the method mix. Cost-benefit analyses will need to evaluate the up-front costs of DMPA-SC for clients, facilities, and health systems compared with the higher continuation rates and saved opportunity-costs over time. Task-shifting strategies and development of mobile phone technologies to assist users in adherence should be considered in future service scale-up.
目的综述：全球范围内，可注射避孕法是一种广泛应用且广受欢迎的计划生育方法。该方法已经过改良，可以进行皮下自我注射（DMPA-SC，醋酸甲羟孕酮-皮下注射）。本综述将重点关注评估 DMPA-SC 的研究，具体涉及续用率、安全性和使用者满意度。
最新发现：来自美国、马拉维、乌干达和塞内加尔的新证据表明，与由医护人员注射相比，自我注射者使用 DMPA-SC 的安全性更高，续用率也更高。DMPA-SC 自我注射者的续用率高出 10-28%。多项研究表明，自我注射者对 DMPA-SC 的满意度非常高，且表示其易于使用。研究表明，续用率可能归因于自我管理和用户自主权，而不是 DMPA-SC 注射本身的固有特性。
总结：应在高资源和低资源环境中提供 DMPA-SC。未来的工作重点应放在实施上，并评估如何最好地将 DMPA-SC 添加到方法组合中。成本效益分析需要评估 DMPA-SC 对客户、设施和卫生系统的前期成本，以及随着时间的推移，续用率提高和机会成本降低所带来的效益。未来在扩大服务规模时，应考虑将任务转移策略和开发手机技术以帮助用户坚持使用相结合。
