Subcutaneous DMPA (DMPA-SC, Sayana Press) Feasibility and Acceptability

Corporate author(s): PATH, John Snow Inc. (JSI)

Publication date: January 2018

Available materials

1. 1. Logistics and Waste Management Benefits of depo-subQ in Uniject (2011)

      This four-page brief describes results from three analyses conducted by PATH and John Snow Inc. (JSI) comparing the current intramuscular version of depot medroxyprogesterone acetate (DMPA) injectable contraceptive compared with the new formulation packaged in the Uniject injection system. The analyses focused on waste management implications and identified key quantitative and qualitative differences between the two products. The briefing summary based on these three reports is linked above.

   2. Acceptability of Depo-subQ in Uniject, Now Called “Sayana Press” (2013)

      Through the PROGRESS project, FHI 360 worked with the Uganda and the Senegal Ministry of Health and local partners to assess acceptability of Sayana Press among intramuscular DMPA users and providers and offer recommendations for method introduction. FHI 360 collaborated with the Uganda Ministry of Health and in Senegal, with the Ministry of Health and CEFOREP, with additional support from PATH and Pfizer, and in partnership with the Bill & Melinda Gates Foundation.

   3. Feasibility of Administering Sayana Press in Clinics and Communities: Summary Findings From an Operational Assessment in Senegal (2013)

      This operational assessment of Sayana Press in Senegal examines the extent to which Sayana Press facilitates the logistics of managing and administering injectable contraception and assesses whether providers in Senegal find benefits in this new presentation.

   4. Operational Assessment: Administration and Management of Sayana Press in Clinics and Communities in Uganda (2013)

      This operational assessment of Sayana Press in Uganda examines the extent to which Sayana Press facilitates the logistics of managing and administering injectable contraception and assesses whether providers in Uganda find benefits in this new presentation.

   5. Pharmacokinetics of subcutaneous depot medroxyprogesterone acetate injected in the upper arm (2014)

      Halpern V, Combes SL, Dorflinger LJ, et al. Contraception. 2014;89(1):31–35.
      

      The abdomen and thigh are recommended injection sites in the label for Depo-SubQ Provera 104™ (now known as Sayana Press). The authors evaluated the pharmacokinetic profile of medroxyprogesterone acetate (MPA) following injection of Depo-SubQ Provera 104 in the upper arm, a preferred injection site in developing countries. Study findings indicated that injection of Depo-SubQ Provera 104™ in the upper arm provided sufficient MPA levels for contraceptive protection for 3 months (13 weeks). The uptake and metabolism of MPA when injected in the upper arm may be different from the abdomen and thigh.

   6. Observational study of the acceptability of Sayana® Press among intramuscular DMPA users in Uganda and Senegal (2014)

      Burke HM, Mueller MP, Perry B, et al. Contraception. 2014;89(5):361–367.
      This study measured acceptability of subcutaneous Sayana Press among intramuscular DMPA (DMPA IM) users. This open-label observational study was conducted in clinics in three districts in Senegal and community-based distribution services in two districts in Uganda. Current DMPA IM users in Senegal and Uganda accepted Sayana Press, and most preferred Sayana Press over DMPA IM. Findings indicate that Sayana Press can be safely introduced into family planning programs and administered by trained CHWs, with expectation of client uptake.

   7. Operational assessments of Sayana® Press provision in Senegal and Uganda (2014)

      Cover J, Blanton E, Ndiaye D, Walugembe F, LaMontagne DS. Contraception.2014;89(5):374–378
      Researchers conducted 58 semi-structured interviews with clinic providers and community health workers in Senegal and Uganda to identify the merits, challenges, and appeal of Sayana Press relative to intramuscular DMPA. Findings indicated that adding Sayana Press to the family planning method mix is unlikely to have a profound impact on clinic operations but may lessen logistical problems related to supply, storage, and waste management.

   8. Preference for Sayana® Press versus intramuscular Depo-Provera among HIV-positive women in Rakai, Uganda: a randomized crossover trial (2014)

      Polis CB, Nakgozi GF, Nakawooya H, Mondo G, et al. Contraception. 2014;89(5): 385–395.
      This study assessed acceptability of Sayana Press versus intramuscular DMPA among HIV-positive women and their care providers in Rakai, Uganda. Sayana Press was found to be acceptable to HIV-positive women and health care providers in this rural Ugandan population.

   9. Provider acceptability of Sayana® Press: Results from community health workers and clinic-based providers in Uganda and Senegal (2014)

      Burke HM, Mueller MP, Packer C, et al. Contraception. 2014;89(5): 368–373.
      This open-label observational study was conducted in clinics in three districts in Senegal and community-based services in two districts in Uganda. Providers administered Sayana Press to clients seeking reinjection of intramuscular DMPA. Researchers conducted in-depth interviews with 86 providers to assess their experiences providing Sayana Press to clients. Almost all providers preferred SP over intramuscular DMPA. Provider recommendations should be considered during Sayana Press introduction planning.

   10. Sayana® Press: Can it be a “game changer” for reducing unmet need for family planning? (2014)

       Spieler J. Contraception. 2014;89(5):335–338.
       This article provides an overview of Sayana Press product characteristics, history, and research.

   11. A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection (2017)

       Cover J, Namagembe A, Tumussime J, Lim J, Kidwell Drake J. Contraception. Volume 95, Issue 3, March 2017, Pages 306-311

       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. The results 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.

   12. Evaluating the feasibility and acceptability of self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA) in Senegal: a prospective cohort study (2017)

       Cover J, Ba M, Lim J, Kidwell Drake J, Daff BM. Contraception. Volume 96, Issue 3, September 2017, Pages 203-210

       This study was performed to assess feasibility of subcutaneous DMPA self-injection in Senegal; objectives were to (1) measure the proportion of participants who self-injected competently 3 months after training, (2) measure the proportion who self-injected on time (defined conservatively as within 7 days of reinjection date), and (3) assess acceptability of self-injection. These first research results on contraceptive self-injection in West Africa indicate initial feasibility and acceptability of the practice. Results underscore the importance of designing self-injection programs that empower and support women, including those with limited education.

   13. Self-Injection Feasibility and Acceptability brief (2018)

       PATH

       This brief provides an overview of PATH’s research studies assessing the feasibility and acceptability of DMPA-SC self-injection in Uganda and Senegal.