Self-administration of subcutaneous depot Medroxyprogesterone acetate by adolescent women

Abstract

Background-Intramuscular depot medroxyprogesterone acetate (DMPA-IM) is now available in subcutaneous (SC) formulation, potentially allowing for home-based self-administration. We examined adolescents' interest in and proficiency at DMPA-SC self-administration.Study Design-This is a planned secondary analysis of a randomized controlled trial comparing pain between DMPA-IM and DMPA-SC. In the trial, study participants (N=55) aged 14-21 years were recruited at DMPA initiation and randomized to receive DMPA-IM or DMPA-SC. Participants received the alternate formulation at 3 months, chose formulation at 6 months, and could learn self-administration at 9 months. The current analysis is of the women who chose selfadministration of DMPA-SC. Proficiency was rated for each step of self-administration: independently [I], with reassurance [R], with verbal instruction [V], or nurse performed [RN].Data were analyzed using descriptive and comparative statistics.Results-Thirty-five percent (19/55) of participants learned self-administration. Proficiency ratings were: chose injection site (I=78.9%, R=5.3%, V=5.3%, RN=10.5%); cleaned site (I=89.5%, RN=10.5%); assembled injection device (I=47.4%, R=36.8%, V=15.8%), self-injected (I=31.6%, R=36.8%, V=15.8%, RN=15.8%), and disposed of device (I=21.1%, R=21.1%, RN=57.9%).Conclusions-Many adolescents are interested in and capable of DMPA-SC self-administration with brief education and minimal assistance.

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

“…Another study among DMPA-SC clients in Malawi showed that younger self-injectors (18-24 years old) have similar continuity rates with using DMPA-SC compared to older women (21). It had been hypothesized during the roll-out of DMPA-SC in Malawi that the SI option could be a feasible, discreet and convenient option for adolescents, as indicated by studies from other contexts (22)(23)(24), and could even help expand access among adolescents with unmet need for contraceptives. A recent study from Uganda (24) found no significant differences in competence in initial and subsequent SI of DMPA-SC between adolescent self-injectors (aged under 20) and older women, a finding which raises prospects of feasibility of SI among adolescents in similar contexts.…”