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Efforts to Improve the Safety of Delivery of DMPA (Injectable Contraceptive)

Efforts to Improve the Safety of Delivery of DMPA (Injectable Contraceptive). USAID Office of Population August 31, 2001 Presenter: Tabitha Keener, MPH Biomedical Research Fellow. Depo Provera Clients in Year 2000.    USA approximately 3.9 million*

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Efforts to Improve the Safety of Delivery of DMPA (Injectable Contraceptive)

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  1. Efforts to Improve the Safety of Delivery of DMPA (Injectable Contraceptive) USAID Office of Population August 31, 2001 Presenter: Tabitha Keener, MPH Biomedical Research Fellow

  2. Depo Provera Clients in Year 2000 •    USA approximately 3.9 million* •   Worldwide approximately 21.5 million * Depo Provera clients receive 4 injections per year. Approximately 100 million injections per year for Depo Provera. There are other types of injectable contraceptives that USAID does not procure that are monthly injections. *Personal Communcation, Gerry Stoneburner - Pharmacia Corp.

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  4. Phase 1 • Standard Disposable Syringe with Single Dose Vial. • Single dose of DMPA provided with a single, sterile, disposable syringe. • Problem: The syringe can be separated from DMPA with nothing to assure safety of delivery, the device can be reused and no disposal solution is provided

  5. Phase 2 • Auto-Disable Syringe with Single Dose Vial • Single dose of DMPA provided with an auto-disable syringe to prohibit reuse, and a sharps container to facilitate disposal. • Expected launch date: October 2001 • Problem: • The syringe can be separated from DMPA • No reduction in waste volume

  6. Phase 3 • Uniject™ - Prefill Injection Device • Single dose of DMPA integrated into an auto-disable prefilled injection device. • Solution: • Device can not be separated from DMPA • Offers superior dose control • Facilitates safe disposal • Reduces volume of waste (but does not eliminate disposal problem) • Allows option of self or home injection

  7. Pilot Assessment of the Introduction of Auto-Disable Syringes for use with Depo Provera in Uganda • Thanks to: • DELIVER/JSI, especially Tim Williams who carried out the evaluation • CMS/Uganda

  8. Methodology • 19 sites were visited (out of 30) over a three-day period • 7 MOH sites (2 hospitals and 5 health centers) • 2 Family Planning Association of Uganda (FPAU) clinics • 1 Marie Stopes International clinic • 9 private clinics (8 Uganda Private Midwives Association (UPMA), 1 Seventh Day Adventist) • 21 providers were interviewed • The methodology was highly qualitative, and these findings should be viewed in that light.

  9. Sites visited had received 605 AD syringes, and providers at those sites had used approximately 400 by the time of the visit • Respondents interviewed had themselves performed a total of 294 injections with the new syringes • (median 10 injections each, mean 14).

  10. Findings Regarding Use of AD Syringe • All respondents except 2 had used AD syringes in the past for immunization • All providers who had used AD syringes for immunization found the Depo syringes easy to use.

  11. When first learning to use AD syringes for immunizations, most respondents said they had experienced difficulty and had lost some syringes (range 0-10; mean 2.8). • Most said it took 0-5 tries to get used to the syringes (range 0-10; mean 2.9), and that after that, wastage was minimal (roughly estimated at 0/100 – 5 /100; mean 0.6/100).

  12. The main issues reported that still gave providers difficulties included: • Problems getting complete dose without air (N=4). • Problems aspirating for blood (N=4)

  13. Disposal Findings • Providers are aware of the dangers and make honest efforts to dispose of needles/syringes safely, but practices are extremely variable. • Immediately after injection some providers: • cap the needle (N>3) • separate needle from syringe (N>7) • put needles in jik (chlorine bleach) in addition to capping or separating (N>3)

  14. Conclusions • In general, providers in clinical settings in Uganda found the use of AD syringes to be easy. • The prior experience with AD syringes for other kinds of injections should make the introduction of similar syringes for Depo relatively easy in Uganda. • In general, the experience in Uganda seems to suggest that somewhere between 0 – 5 syringes (and smaller amounts of Depo itself) will be “wasted” per site during the short introductory period, due to practice or locking before providers become comfortable with the technique. • This very small wastage rate should not require adjustments to forecasts or procurement decisions regarding Depo • Waste disposal is a major issue to be addressed, but the disposal of AD syringes is no more problematic than for standard syringes.

  15. Proper disposal of all needles and syringes will be an ongoing issue of increasing importance as the use of Depo increases

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