title: Comparing effectiveness of two client follow-up approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) among the underserved in rural Punjab, Pakistan: a study protocol and participants' profile.
abstract: BACKGROUND
  Pakistan observes a very high i.e. 37 percent modern contraceptive method related discontinuation rates within 12 months of their initiation. And almost 10 percent of these episodes of discontinuation happened due to the side effects or health concerns experienced by the women. Most importantly, it was noted that more than 12,000 first-level care facilities are located in the rural areas, including rural health centers, basic health units, and family welfare centers, but more than 30% of these facilities are nonfunctional. This paper presents a study protocol and participants' profiling of a prospective cohort follow-up to compare the effectiveness of household based and telephonic approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) whilst to facilitate lowering method related discontinuation and increasing switching amongst the contraceptive users.
  
  
  METHODS
  A 12-month multi-centre, non-inferiority prospective user follow-up is employed using three different study categories: a) household based follow-up; b) telephonic follow-up; and c) passive or need-based follow-up along with the hypothetical assumption that the telephonic client follow-up is not inferior to the household based follow-up by continuation rate of LARC and the telephonic follow-up is less-costly than the household based client follow-up. This follow-up will be conducted in 22 health facilities - (16 rural and 6 urban based facilities) in district Chakwal. The first two study categories will receive scheduled but different follow-up from the field workers at 1, 3, 6, 9, and 12 month while the third one i.e. the 'passive or need-based follow-up' will serve as a control group. Using sampling software PASS 11, it was estimated to have 414 clients in each study category and around 1366 clients will be recruited to account for 10% attrition rate.
  
  
  CONCLUSIONS
  The study will help us to examine a more convenient method of effective follow-up for managing side effects, decreasing method discontinuation and increasing switching amongst users. The study information will also facilitate to develop a robust, effective and efficient mechanism for client follow-up to promote the continuation rates of LARC methods. The follow-up results and lessons learnt will be widely shared with stakeholders for their implementation and streamlining in health system.
authors.affiliation: Department of Uro-gynecology, Ghent University, Sint-Pietersnieuwstraat 25, B-9000, Ghent, Belgium. SyedKhurram.Azmat@UGent.be.|Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. SyedKhurram.Azmat@UGent.be.
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. waqas.hameed@mariestopespk.org.
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211, Geneva 27, Switzerland. alimoa@who.int.
authors.forename: Moazzam
authors.initials: M
authors.lastname: Ali
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. ishaque.sheikh@mariestopespk.org.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ishaque
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. ghulam.mustafa@mariestopespk.org.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. dr.omar@mariestopespk.org.
authors.forename: Omar Farooq
authors.initials: OF
authors.lastname: Khan
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. ghazanfer.abbas@mariestopespk.org.
authors.forename: Ghazunfer
authors.initials: G
authors.lastname: Abbas
authors.affiliation: Research, Monitoring and Evaluation Department, Marie Stopes International, London, UK. erik.munroe@mariestopes.org.
authors.forename: Erik
authors.initials: E
authors.lastname: Munroe
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003267:Contraception / Q000379:methods*; D003270:Contraceptive Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D010154:Pakistan; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors
chemical_list: D003270:Contraceptive Agents