Acceptability of depo-subq in uniject: Results from Uganda and Senegal

Depot medroxyprogesterone acetate (DMPA) is a widely used injectable contraceptive given by the intramuscular (IM) route. A subcutaneous formulation of DMPA delivered in a prefilled, auto-disabled injection system called Uniject was developed to address persistent logistics and safety challenges posed by widespread distribution of DMPA IM in low-resource settings. It is anticipated that this new method will be a valuable innovation in family planning service delivery. This outcome hinges on the method being affordable and acceptable to decision makers, family planning providers, and clients. This study assessed acceptability of depo-subQ in Uniject among clients and providers, including community health workers (CHWs). User trials in family planning clinics and with clients of CHWs were conducted in Senegal and Uganda July 2012 through March 2013. Pre- and post-injection questionnaires were administered to 362 continuing DMPA IM clients who received the subcutaneous injection. Participants were followed up three months post-injection to further assess their experience with the method. Eligible DMPA clients who declined to receive depo-subQ in Uniject were invited to complete a questionnaire about their reasons for declining. In-depth interviews were conducted with 66 CHWs and 20 clinic-based providers to assess their experiences providing the method. In this presentation, we will present client and provider preferences for depo-subQ in Uniject compared to DMPA IM and describe the reasons for these preferences. We will present recommendations for the introduction of depo-subQ in Uniject on three levels — country, community, and health facility. The potential for self-injection in these communities will also be discussed.