A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection
A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection
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DOI：
10.1016/j.contraception.2016.10.007
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发表时间：
2017-03-01
期刊：
影响因子：
2.9
通讯作者：
Mbonye, Anthony K.
中科院分区：
文献类型：
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作者：
Cover, Jane;Namagembe, Allen;Mbonye, Anthony K.
目的：来自美国和类似环境的避孕自我注射的证据是有希望的，这种做法可能会增加获得的机会。到目前为止，还没有关于撒哈拉以南非洲地区自我注射避孕可行性的研究发表。本研究的目的是评估乌干达皮下注射醋酸甲羟孕酮的可行性，具体目标是：(A)测量参与者自我注射能力的比例，(B)测量培训后3个月按时自我注射的比例(保守地定义为重新注射日期后7天内)，以及(C)评估可接受性。研究设计：在这项前瞻性队列研究中，380名18-45岁的参与者在注册研究护士的指导下完成自我注射培训，并在客户指导手册的指导下进行假肢注射，直到达到能力为止。护士监督参与者的自我注射，并使用观察检查表评估注射技术。3个月后，被认为有能力的人在家中接受了Sayana(R)Press Under、说明书和再注射日历的自我注射。参与者在自我注射前后完成了一次访谈。结果：368名学员在培训后3个月的随访中，88%[95%可信区间(CI)=84~91]显示出注射能力，95%(95%CI=92~97)按时再次注射，87%(95%CI=84~90)既能按时注射，又能胜任。几乎所有人(98%)都表达了继续注射的愿望。结论：自我注射在乌干达大多数研究参与者中是可行的，并被高度接受。影响：在撒哈拉以南非洲关于自我注射避孕的第一个研究结果表明，在妇女接受一对一培训和高度视觉训练和记忆辅助3个月后，这种做法初步可行和可接受。结果可以为旨在增加妇女自主权和获得可注射避孕药具的自我注射方案提供参考。(C)2017年作者。由爱思唯尔公司出版。
Objectives: Evidence on contraceptive self-injection from the United States and similar settings is promising, and the practice may increase access. There are no published studies on the feasibility of contraceptive self-injection in sub-Saharan Africa to date. The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability.Study design: In this prospective cohort study, 380 18-45-year-old participants completed self-injection training by licensed study nurses, guided by a client instruction booklet, and practiced injection on prosthetics until achieving competence. Nurses supervised participants' self injection and evaluated injection technique using an observation checklist. Those judged competent were given a Sayana (R) Press unit, instruction booklet and reinjection calendar for self-injection at home 3 months later. Participants completed an interview before and after self-injection. Nurses visited participants at home following reinjection dates; during the follow-up visit, participants demonstrated self injection on a prosthetic, injection technique was reevaluated, and a postreinjection interview was completed.Results: Of 368 participants followed up 3 months posttraining, 88% [95% confidence interval (CI) = 84-91] demonstrated injection competence, and 95% (95% C1=92-97) reinjected on time, while 87% (95% CI=84-90) were both on time and competent. Nearly all (98%) expressed a desire to continue.Conclusions: Self-injection is feasible and highly acceptable among most study participants in Uganda.Implications: The first research results on contraceptive self-injection in sub-Saharan Africa indicate initial feasibility and acceptability of the practice 3 months after women received one-on-one training and a highly visual training and memory aid. Results can inform self injection programs which aim to increase women's autonomy and access to injectable contraception. (C) 2017 The Authors. Published by Elsevier Inc.