title: Provider acceptability of Sayana® Press: results from community health workers and clinic-based providers in Uganda and Senegal.
abstract: BACKGROUND
  Sayana® Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) in Uniject™, has potential to be a valuable innovation in family planning (FP) because it may overcome logistic and safety challenges in delivering intramuscular DMPA (DMPA IM). However, SP's acceptability is unknown. We measured acceptability of SP among clinic-based providers (Senegal only) and community health workers.
  
  
  METHODS
  This open-label observational study was conducted in clinics in three districts in Senegal and community-based services in two districts in Uganda. Providers administered SP to clients seeking reinjection of DMPA IM. We conducted in-depth interviews with 86 providers (52 in Senegal, 34 in Uganda) to assess their experiences providing SP to clients.
  
  
  RESULTS
  Almost all providers (84/86; 98%) preferred SP over DMPA IM. The main reason Uganda providers preferred SP was the prefilled/all-in-one design made preparation and administration easier and faster. Some providers thought the SP all-in-one feature may decrease stock outs (DMPA IM requires syringe and vial). Providers also felt clients preferred the shorter SP needle because it is less intimidating and less painful. Similarly, the main reasons Senegal providers preferred SP were its characteristics (prefilled/all-in-one) and client preference (especially less pain). They also saw a potential to increase access to FP, especially through community-based distribution. Providers from both countries reported SP introduction would be enhanced through client counseling and community engagement. Providers also said SP must be accessible, affordable and in stock.
  
  
  CONCLUSIONS
  Almost all providers preferred SP over DMPA IM. Provider recommendations should be considered during SP introduction planning.
  
  
  CONCLUSIONS
  We found that SP was acceptable to both clinic-based FP providers and community health workers. Providers' positive attitudes towards SP may facilitate introduction and uptake of this method.
authors.affiliation: FHI 360, Durham, NC. Electronic address: hburke@fhi360.org.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Burke
authors.affiliation: FHI 360, Durham, NC.
authors.forename: Monique P
authors.initials: MP
authors.lastname: Mueller
authors.affiliation: FHI 360, Durham, NC.
authors.forename: Catherine
authors.initials: C
authors.lastname: Packer
authors.affiliation: FHI 360, Durham, NC.
authors.forename: Brian
authors.initials: B
authors.lastname: Perry
authors.affiliation: FHI 360, Kampala, Uganda.
authors.forename: Leonard
authors.initials: L
authors.lastname: Bufumbo
authors.affiliation: Centre de Formation et de Recherche en Santé de la Reproduction (CEFOREP), Senegal.
authors.forename: Daouda
authors.initials: D
authors.lastname: Mbengue
authors.affiliation: Ministry of Health and Social Action, Senegal.
authors.forename: Bocar Mamadou
authors.initials: BM
authors.lastname: Daff
authors.affiliation: Ministry of Health, Uganda.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mbonye
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D008875:Middle Aged; D012675:Senegal; D014454:Uganda
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: Community health worker; Contraception; Depot medroxyprogesterone acetate (DMPA); Subcutaneous injection