Introducing Long-Acting Contraceptive Removal Indicators in a Pilot Study in Mozambique: Dynamics of Discontinuation and Implications for Quality of Care

Jacinto, Ana; Ronda, Adalgisa Viola; Lee, Connie; Fikree, Fariyal F.; Ramirez-Ferrero, Eric

doi:10.9745/ghsp-d-21-00252

Cited by 2 publications

(4 citation statements)

References 18 publications

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“…As in Nigeria, LARC removals are not routinely captured in health facility registers or the national HMIS. In Mozambique, Jacinto et al note that documenting outcomes of LARC removals could help health management teams identify increases in difficult removals and encourage assessment of provider competencies and adequacy of supplies and equipment ( 21 ). Governments should consider including removal indicators in their national HMIS to strengthen monitoring of family planning initiatives to improve the quality of care.…”

Section: Discussionmentioning

confidence: 99%

“…These difficult removals may require referral to other providers and/or facilities with appropriate capacity and ultrasound or x-ray availability ( 20 ). Adequate planning, resource allocation and placement, and data to drive quality improvement are needed to ensure availability of these services, particularly for difficult removals ( 21 ).…”

Section: Introductionmentioning

confidence: 99%

“…Referral protocols, availability of equipment and job aids, supportive supervision/mentoring, and other quality improvement activities support capacity building for quality implant removal services, particularly in cases of difficult removal. Last, systematic capture, synthesis, and analysis of data on removals is integral to developing action plans, scaling up access, and ensuring accountability in providing this essential service ( 21 ). However, few countries routinely track removals and reasons for removal.…”

Section: Introductionmentioning

confidence: 99%

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What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment

Oniyire¹,

Danladi²,

Haws³

et al. 2023

Front. Glob. Womens Health

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IntroductionStunning recent increases in subdermal contraceptive implant use, especially in sub-Saharan Africa, necessitate availability of quality implant removal services. In Nigeria, service delivery capacity and coverage for removal are lacking, despite strong government commitment and rapid uptake; there is a dearth of knowledge about barriers to quality implant removals in Nigeria.MethodsTo determine access to and quality of contraceptive implant removal services, a landscape assessment was conducted in two states in Nigeria, focusing on four conditions for quality delineated in the Global Implant Removals Task Force framework. This mixed-methods approach integrated results from a desk review, a survey of health facilities and family planning managers, review of implant service statistics, and key informant interviews with providers and diverse stakeholders.ResultsSeventy percent of providers (N = 21 of 30) had experienced problems performing implant removal, usually due to deeply inserted implants and equipment shortages. Providers had low confidence in performing removal and poor knowledge of implant removal steps. No facilities assessed had comprehensive equipment required for implant removal. Few facilities maintained systems or referral pathways to support difficult removals; difficult removals are absent from training manuals, and no formal trainings have been conducted. While most facilities collect data on removals, family planning dashboards do not capture it; few facilities use data for quality improvement.ConclusionThis study identified numerous challenges to quality implant removal, including poorly trained providers, inadequate supplies, underutilization of data on removals, and inability to manage difficult removals. As demand for implant removals skyrockets, providers need improved training in implant removal, appropriate job aids, supportive supervision, and effective procurement systems to ensure availability of supplies and equipment for removal. Tracking removals and reasons for removal in information systems and the Family Planning dashboard could sensitize providers to need for implant removals and improve data for decision-making in facilities and health systems.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment

Oniyire¹,

Danladi²,

Haws³

et al. 2023

Front. Glob. Womens Health

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“…[3][4][5][6] Despite recent increases in long-acting reversible contraception (LARC) use, barriers persist to accessing LARC removal services (eg, inadequate insurance coverage, cost, clinic policy, or clinician bias), which usually require a clinic visit. [7][8][9][10] Research on contraceptive switching and discontinuation (usually defined as stopping a method without evidence of another method within 30 days) is generally limited to 6 or 12 months after initiation 4,[11][12][13][14] or is conducted among samples with no-cost initiation and removal as part of a study protocol, as opposed to real-world settings. 4,13,14 We have limited evidence about method switching, specifically LARC removal, over longer periods and among large diverse settings.…”

mentioning

confidence: 99%

Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016–2021

Darney

Biel

Oakley

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. METHODS: We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. RESULTS: Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0–20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1–17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8–31.6% in patients aged 12–14 years) and decreased in a dose–response relationship by age to 8.4% (95% CI 7.4–9.4%) among patients aged 45–49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. CONCLUSION: Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.

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Introducing Long-Acting Contraceptive Removal Indicators in a Pilot Study in Mozambique: Dynamics of Discontinuation and Implications for Quality of Care

Cited by 2 publications

References 18 publications

What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment

What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment

Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016–2021

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