Introduction of subcutaneous depot medroxyprogesterone acetate through use of community-based distributors in Zambia

Abstract

Background: The majority of women in Sub-Saharan countries including Zambia use intramuscular Depot Medroxyprogesterone Acetate (DMPA IM) as their preferred method of contraception. However, nearly one-third of the women who start on DMPA IM discontinue within 12 months due to access barriers.  Sayana® Press, low-dose, prefilled subcutaneous depot medroxyprogesterone acetate (DMPA-SC), suitable for even lower-level healthcare providers and potential for self-injection administration, has been developed.  This pilot aimed to understand the feasibility of DMPA-SC in Zambia through use of community-based distributors (CBDs). Methods: The pilot was implemented from May 2017 to July 2017 in 29 public health facilities in three districts. A total of 161 CBDs received a comprehensive training in DMPA-SC, which included counselling about the method, potential side effects, correct administration and waste management. Post-training mentorship and supervision was conducted. Routine client level data was collected through Ministry of Health management information system. Results: During the pilot, 12,818 clients were provided with modern voluntary FP methods, with 16.4% (2,100) opting for DMPA-SC. The age range of clients opting for DMPA-SC was between 15 and 50 years, with an average of 31 years. Slightly less than half (43%) of DMPA-SC clients were adolescents and young women, with 11% aged 15–19 and 32% aged 20–24. No adverse events were reported during or immediately subsequent to the introduction of DMPA-SC administration by CBDs. Conclusion: The pilot demonstrated that CBDs can safely provide DMPA-SC at the community level with appropriate public sector coordination and oversight.