Increased 1-year continuation of DMPA among women randomized to self-administration: results from a randomized controlled trial at Planned Parenthood

Autor: Elizabeth Talmont, Anitra Beasley, Lisa Della Badia, Elissa Draper, Hannah R. Simons, Melanie McDonald, Julia E. Kohn, Johanna Morfesis, Carolyn Westhoff
Rok vydání: 2018
Předmět:
Adult
medicine.medical_specialty
Adolescent
Injections
Subcutaneous
Self Administration
Medroxyprogesterone Acetate
Text message
Ambulatory Care Facilities
law.invention
Young Adult
03 medical and health sciences
Continuation
0302 clinical medicine
Randomized controlled trial
law
Surveys and Questionnaires
Contraceptive Agents
Female
medicine
Humans
Medroxyprogesterone acetate
030212 general & internal medicine
Adverse effect
Contraception Behavior
Response rate (survey)
Pregnancy
030219 obstetrics & reproductive medicine
New Jersey
business.industry
Obstetrics and Gynecology
General Medicine
medicine.disease
Texas
Reproductive Medicine
Patient Satisfaction
Delayed-Action Preparations
International Planned Parenthood Federation
Usual care
Physical therapy
Feasibility Studies
Female
Self-administration
business
medicine.drug
Zdroj: Contraception. 97:198-204
ISSN: 0010-7824
DOI: 10.1016/j.contraception.2017.11.009
Popis: Objectives Self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-sc) is feasible, acceptable, and effective. Our objective was to compare one-year continuation of DMPA-sc between women randomized to self-administration versus clinic administration. Study design We randomized 401 females ages 15–44 requesting DMPA at clinics in Texas and New Jersey to self-administration or clinic administration in a 1:1 allocation. Clinic staff taught participants randomized to self-administration to self-inject and observed the first injection; participants received instructions, a sharps container, and three doses for home use. Participants randomized to clinic administration received usual care. All participants received DMPA-sc at no cost and injection reminders via text message or email. We conducted follow-up surveys at six and 12 months. Results Three hundred thirty-six participants (84%) completed the 12-month survey; 316 completed both follow-up surveys (an 80% response rate excluding eight withdrawals). Participants ranged in age from 16–44. One-year DMPA continuous use was 69% in the self-administration group and 54% in the clinic group (p=.005). There were three self-reported pregnancies during the study period, all occurred in the clinic group; all three women had discontinued DMPA and one reported her pregnancy as intended. Among the self-administration group, 97% reported that self-administration was very or somewhat easy; 87% would recommend self-administration of DMPA-sc to a friend. Among the clinic group, 52% reported interest in self-administration in the future. Satisfaction was similar between groups. No serious adverse events were reported. Conclusions DMPA self-administration improves contraceptive continuation and is a feasible and acceptable option for women and adolescents. Implications Self-administration of subcutaneous DMPA can improve contraceptive access, autonomy, and continuation, and is a feasible and acceptable option for women and adolescents. It should be made widely available as an option for women and adolescents.
Databáze: OpenAIRE
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