title: A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection.
abstract: OBJECTIVE
  Evidence on contraceptive self-injection from the United States and similar settings is promising, and the practice may increase access. There are no published studies on the feasibility of contraceptive self-injection in sub-Saharan Africa to date. The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability.
  
  
  METHODS
  In this prospective cohort study, 380 18-45-year-old participants completed self-injection training by licensed study nurses, guided by a client instruction booklet, and practiced injection on prosthetics until achieving competence. Nurses supervised participants' self-injection and evaluated injection technique using an observation checklist. Those judged competent were given a Sayana® Press unit, instruction booklet and reinjection calendar for self-injection at home 3 months later. Participants completed an interview before and after self-injection. Nurses visited participants at home following reinjection dates; during the follow-up visit, participants demonstrated self-injection on a prosthetic, injection technique was reevaluated, and a postreinjection interview was completed.
  
  
  RESULTS
  Of 368 participants followed up 3 months posttraining, 88% [95% confidence interval (CI)=84-91] demonstrated injection competence, and 95% (95% CI=92-97) reinjected on time, while 87% (95% CI=84-90) were both on time and competent. Nearly all (98%) expressed a desire to continue.
  
  
  CONCLUSIONS
  Self-injection is feasible and highly acceptable among most study participants in Uganda.
  
  
  CONCLUSIONS
  The first research results on contraceptive self-injection in sub-Saharan Africa indicate initial feasibility and acceptability of the practice 3 months after women received one-on-one training and a highly visual training and memory aid. Results can inform self-injection programs which aim to increase women's autonomy and access to injectable contraception.
authors: PATH, PO Box 900922, Seattle, WA 98109, USA. Electronic address: jcover@path.org.
authors: Jane
authors: J
authors: Cover
authors: PATH, PO Box 7404, Kampala, Uganda. Electronic address: anamagembe@path.org.
authors: Allen
authors: A
authors: Namagembe
authors: PATH, PO Box 7404, Kampala, Uganda. Electronic address: jtumusiime@path.org.
authors: Justine
authors: J
authors: Tumusiime
authors: PATH, PO Box 900922, Seattle, WA 98109, USA. Electronic address: jlim@path.org.
authors: Jeanette
authors: J
authors: Lim
authors: PATH, PO Box 900922, Seattle, WA 98109, USA. Electronic address: jdrake@path.org.
authors: Jennifer Kidwell
authors: JK
authors: Drake
authors: Uganda Ministry of Health, PO Box 7272, Kampala, Uganda. Electronic address: akmbonye@yahoo.com.
authors: Anthony K
authors: AK
authors: Mbonye
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004209:Disposable Equipment; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D061214:Patient Safety; D011446:Prospective Studies; D012646:Self Administration; D014454:Uganda; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: DMPA-SC; Home and self-injection; Injectable contraception; Sayana® Press; Self-administration