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Acceptability and use-effectiveness of Depo-subQ provera 104 administered via Uniject versus conventional intramuscular Depo-Provera among HIV-positive women and family planning providers in Rakai, Uganda

Chelsea Polis, Johns Hopkins Bloomberg School of Public Health, 2010

Project abstract

HIV-positive (HIV+) women are in need of family planning to avoid unintended pregnancy and mother-to-child HIV transmission. In Rakai, Uganda, during 2006, 48% of pregnancies to HIV+ women were unintended. Although injectable contraception is the most popular hormonal method, only 16% of HIV+ women currently use it. There is a need to improve access to family planning, particularly injectable contraception, in this population.

We propose to assess the acceptability and use-effectiveness of a low-dose injectable contraceptive formulation called Depo-subQ provera 104 (Depo-subQ), delivered via Uniject (a pre-filled, single-use, subcutaneous injection system), as compared with conventional Depo-Provera administered intramuscularly (imDP) among HIV+ women who attend mobile clinics for HIV care in Rakai, Uganda.

Approximately 3,250 HIV+ women receive HIV care via 17 mobile clinics provided by the Rakai Health Sciences Program (RHSP). These clinics visit each community at bimonthly intervals, and women receive support from community health workers and peer educators between clinic visits. They are offered counseling and a variety of free contraceptive methods.

Women who select contraceptive injections will be asked to enroll in a six-month study, and randomized to receive either imDP or Depo-SubQ. We will collect information on pregnancy rates, continuation rates and reasons for discontinuation, side effects, and user acceptability and satisfaction by surveying women pre- and post-initial injection, as well as three and six months after baseline. We will also assess provider acceptability and problems encountered. Finally, we will assess women’s perceptions of and attitudes towards receiving contraceptive injections provided by community health workers, as well as the potential acceptability of self-administered injections.

This study will inform efforts to expand access to injectable contraception in a population in great need of family planning services.

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