title: Randomized clinical trial of self versus clinical administration of subcutaneous depot medroxyprogesterone acetate.
abstract: OBJECTIVE
  To evaluate feasibility, acceptability, continuation, and trough serum levels following self-administration of subcutaneous (sc) depot medroxyprogesterone acetate (DMPA).
  
  
  METHODS
  Women presenting to a family planning clinic to initiate, restart or continue DMPA were offered study entry. Participants were randomized in a 2:1 ratio to self- or clinician administered sc DMPA 104 mg. Those randomized to self-administration were taught to self-inject and were supervised in performing the initial injection; they received printed instructions and a supply of contraceptive injections for home use. Participants randomized to clinician administration received usual care. Continued DMPA use was assessed by self-report and trough medroxyprogesterone acetate levels at 6 and 12 months.
  
  
  RESULTS
  Two hundred fifty women were invited to participate, and 137 (55%) enrolled. Of these, 91 were allocated to self-administration, and 90/91 were able to correctly self-administer sc DMPA. Eighty-seven percent completed follow-up. DMPA use at 1 year was 71% for the self-administration group and 63% for the clinic group (p=0.47). Uninterrupted DMPA use was 47% and 48% for the self and clinic administration groups at 1 year (p=0.70), respectively. Serum analyses confirmed similar mean DMPA levels in both groups and therapeutic trough levels in all participants.
  
  
  CONCLUSIONS
  Sixty-three percent of women approached were interested in trying self-administration of DMPA, even in the context of a randomized trial, and nearly all eligible for enrollment were successful at doing so. Self-administration and clinic administration resulted in similar continuation rates and similar DMPA serum levels. Self-administration of sc DMPA is feasible and may be an attractive alternative for many women.
  
  
  CONCLUSIONS
  Self-administration of sc DMPA is a feasible and attractive option for many women. Benefits include increased control over contraceptive measures and less time spent on contracepting behaviors. Globally, self-administration has the potential to revolutionize contraceptive uptake by increasing the number of women with access to DMPA.
authors.affiliation: Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX 77030. Electronic address: anitra.beasley@bcm.edu.
authors.forename: Anitra
authors.initials: A
authors.lastname: Beasley
authors.affiliation: Department of Obstetrics & Gynecology, Baystate Medical Center, Springfield, MA 01199.
authors.forename: Katharine O'Connell
authors.initials: KO
authors.lastname: White
authors.affiliation: Irving Institute for Clinical and Translational Research, Columbia University, New York, NY 10032.
authors.forename: Serge
authors.initials: S
authors.lastname: Cremers
authors.affiliation: Department of Obstetrics & Gynecology, Columbia University, New York, NY 10032.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Westhoff
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D012646:Self Administration; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: Contraception; Depot medroxyprogesterone acetate; Injectable; Self-administration