title: Impact of a provider job aid intervention on injectable contraceptive continuation in South Africa.
abstract: Arriving late for scheduled contraceptive reinjections is common in many countries and contributes to discontinuation when providers are unsure how to manage such clients. A clinic-randomized cohort and cross-sectional study with more than 5,000 clients using injectable contraceptives was conducted in the Eastern Cape province of South Africa to test the effectiveness of a provider job aid for managing late-returning clients and promoting continued use of the method. A marginally significant difference in reinjection rates between intervention and control groups was found for those up to two weeks late, and reanalysis excluding one clinic that experienced stockout issues revealed a significant difference. The difference in reinjection rates for those 2-12 weeks late was also found to be significant. The one-reinjection cycle continuation rate for the intervention group was higher than that for the control group, but the difference was not statistically significant. Appropriate management of late-returning clients is critical, and this study illustrates that reinjection rates can be significantly increased with a low-resource provider job aid.
authors.affiliation: Social and Behavioral Health Sciences, FHI 360, 1825 Connecticut Avenue NW, Washington, DC 20009, USA. jbaumgartner@fhi360.org
authors.forename: Joy Noel
authors.initials: JN
authors.lastname: Baumgartner
authors.forename: Chelsea
authors.initials: C
authors.lastname: Morroni
authors.forename: Regina Dlakulu
authors.initials: RD
authors.lastname: Mlobeli
authors.forename: Conrad
authors.initials: C
authors.lastname: Otterness
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Buga
authors.forename: Mario
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002985:Clinical Protocols; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003376:Counseling / Q000458:organization & administration; D003430:Cross-Sectional Studies; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007273:Injections, Intramuscular; D007318:Inservice Training / Q000458:organization & administration; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D017150:Public Sector; D012959:Socioeconomic Factors; D013019:South Africa; D013997:Time Factors
chemical_list: D003271:Contraceptive Agents, Female