Abstract
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.
Abbreviations:
DMPA (depot medroxyprogesterone acetate), DMPA-IM (intramuscular depot medroxyprogesterone acetate), DMPA-sc (subcutaneous depot medroxyprogesterone acetate)Keywords
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Article info
Publication history
Published online: December 12, 2017
Accepted:
November 28,
2017
Received in revised form:
October 26,
2017
Received:
August 23,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
