Cover Jane, Namagembe Allen, Morozoff Chloe, Tumusiime Justine, Nsangi Damalie, Drake Jen Kidwell
PATH, Seattle, WA, United States.
PATH, Kampala, Uganda.
Front Glob Womens Health. 2022 Aug 18;3:911107. doi: 10.3389/fgwh.2022.911107. eCollection 2022.
Contraceptive self-injection (SI) is a new self-care practice with potential to transform women's family planning access by putting a popular method, injectable contraception, directly into the hands of users. Research shows that SI is feasible and acceptable; evidence regarding how to design and implement SI programs under real-world conditions is still needed. This evaluation examined women's experiences when self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was introduced in Uganda alongside other contraceptive options in the context of informed choice. We conducted structured survey interviews with 958 randomly selected SI clients trained in three districts in 2019. SI clients demonstrated their injection technique on a model to permit an assessment of injection proficiency. A randomly selected subset of 200 were re-interviewed 10-17 months post-training to understand resupply experiences, waste disposal practices and continuation. Finally, we conducted survey interviews with a random sample of 200 clients who participated in training but declined to self-inject. Data were analyzed using Stata IC/14.2. Differences between groups were measured using chi square and -tests. Multivariate analyses predicting injection proficiency and SI adoption employed mixed effects logistic regression. Nearly three quarters of SI clients (73%) were able to demonstrate injection proficiency without additional instruction from a provider. Years of education, having received a complete training, practicing, and taking home a job aid were associated with higher odds of proficiency. Self-reported satisfaction and continuation were high, with 93% reinjecting independently 3 months post-training. However, a substantial share of those trained opted not to self-inject. Being single, having a partner supportive of family planning use, training with a job aid, practicing, witnessing a demonstration and exposure to a full training were associated with higher odds of becoming an SI client; conversely, those trained in a group had reduced odds of becoming an SI client. The self-care program was successful for the majority of women who became self-injectors, enabling most women to demonstrate SI proficiency. Nearly all those who opted to self-inject reinjected independently, and the majority continued self-injecting for at least 1 year. Additional research should identify strategies to facilitate adoption by women who wish to self-inject but face challenges.
避孕自我注射（SI）是一种新的自我保健方式，它有可能通过将一种流行的避孕方法——注射用避孕药直接交到使用者手中，来改变女性获得计划生育服务的途径。研究表明，避孕自我注射是可行且可接受的；但仍需要有关如何在现实世界条件下设计和实施避孕自我注射项目的证据。本评估考察了在乌干达将皮下注射醋酸甲羟孕酮（DMPA-SC）与其他避孕选择一同引入并提供知情选择的背景下，女性进行自我注射的体验。我们对2019年在三个地区接受培训的958名随机抽取的避孕自我注射服务对象进行了结构化问卷调查访谈。避孕自我注射服务对象在一个模型上展示了她们的注射技术，以便对注射熟练程度进行评估。对随机抽取的200名服务对象在培训后10至17个月进行了再次访谈，以了解她们的补充药物经历、废物处理做法和持续使用情况。最后，我们对200名参加了培训但拒绝自我注射的服务对象进行了随机抽样问卷调查访谈。使用Stata IC/14.2软件对数据进行分析。使用卡方检验和t检验来衡量组间差异。预测注射熟练程度和采用避孕自我注射的多变量分析采用混合效应逻辑回归。近四分之三（73%）的避孕自我注射服务对象能够在没有提供者额外指导的情况下展示注射熟练程度。受教育年限、接受完整培训、进行练习以及带回一份操作指南与熟练程度的较高几率相关。自我报告的满意度和持续使用率很高，93%的人在培训后3个月能够独立再次注射。然而，很大一部分接受培训的人选择不进行自我注射。单身、有支持计划生育使用的伴侣、使用操作指南进行培训、进行练习、观看示范以及接受完整培训与成为避孕自我注射服务对象的较高几率相关；相反，在小组中接受培训的人成为避孕自我注射服务对象的几率降低。对于大多数成为自我注射者的女性来说，自我保健项目是成功的，使大多数女性能够展示避孕自我注射的熟练程度。几乎所有选择自我注射的人都能独立再次注射，并且大多数人持续自我注射至少1年。后续研究应确定策略，以促进那些希望自我注射但面临挑战的女性采用这种方式。
