title: Preference for Sayana® Press versus intramuscular Depo-Provera among HIV-positive women in Rakai, Uganda: a randomized crossover trial.
abstract: BACKGROUND
  Sayana Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) prefilled in a Uniject injection system, could potentially improve and expand contraceptive injection services, but acceptability of SP is unknown. HIV-positive women need contraception to avoid unintended pregnancy and risk of vertical HIV transmission. We assessed acceptability of SP versus intramuscular DMPA (DMPA-IM) among HIV-positive women and their care providers in Rakai, Uganda.
  
  
  METHODS
  Women were randomized to DMPA-IM or SP at baseline, received the alternate product at 3 months, and chose their preferred method at 6 months. We determined preferences among new and experienced contraceptive injectable users who had tried both types of injection during the trial, and from providers before and after providing both types of injectables to clients.
  
  
  RESULTS
  Among 357 women randomized, 314 were followed up at 6 months (88%). Although SP caused more skin irritation than DMPA-IM (3.8% vs. 0% at 6 months, p=.03), it was associated with marginally fewer side effects (30.4% vs. 40.4% at 6 months, p=.06). Participants reported high levels of willingness to recommend the DMPA contraception to a friend and satisfaction with the injection received, and these did not differ by injection type. Sixty-four percent of women and 73% of providers preferred SP to DMPA-IM at 6 months; women's preferences did not differ by previous experience with injectable contraception.
  
  
  CONCLUSIONS
  SP is acceptable to HIV-positive women and health care providers in this rural Ugandan population.
  
  
  CONCLUSIONS
  SP appears to be acceptable to HIV-positive women and their care providers in Rakai, Uganda, and strategies for appropriate rollout of this innovative technology should be explored.
authors: Office of Population and Reproductive Health, United States Agency for International Development (USAID), Washington, D.C., 20004, USA; Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, 21205, USA. Electronic address: cpolis@usaid.gov.
authors: Chelsea B
authors: CB
authors: Polis
authors: Rakai Health Sciences Program, Kalisizo, Uganda.
authors: Gertrude F
authors: GF
authors: Nakigozi
authors: Rakai Health Sciences Program, Kalisizo, Uganda.
authors: Hadijja
authors: H
authors: Nakawooya
authors: Rakai Health Sciences Program, Kalisizo, Uganda.
authors: George
authors: G
authors: Mondo
authors: Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda.
authors: Fredrick
authors: F
authors: Makumbi
authors: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, 21205, USA.
authors: Ronald H
authors: RH
authors: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D018592:Cross-Over Studies; D005260:Female; D015658:HIV Infections; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D007279:Injections, Subcutaneous / Q000009:adverse effects; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data; D014454:Uganda; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: Acceptability; Contraception; Injectable; Intramuscular; Subcutaneous