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Experience with DMPA-SC: Delivery Points—Part Two

Experience with DMPA-SC: Delivery Points—Part Two. Home/self injection in Uganda Fiona Walugembe Tuesday, January 31, 2017 Increasing Access to Next Generation Injectables Dakar, Senegal. W hat is the status of DMPA-SC access in Uganda, including through self-injection?.

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Experience with DMPA-SC: Delivery Points—Part Two

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  1. Experience with DMPA-SC:Delivery Points—Part Two Home/self injection in Uganda Fiona Walugembe Tuesday, January 31, 2017 Increasing Access to Next Generation Injectables Dakar, Senegal

  2. What is the status of DMPA-SC access in Uganda, including through self-injection? • Community-based distribution (CBD) widely available, expanding: DMPA-SC was introduced through CBD in ~30 of 112 districts between 2014 and 2016. • More than 130,000 doses were administered during that period. • MOH, PATH and partners now developing a national scale-up plan that will deliver the product through CBD as well as clinics • Health workers were also trained to administer DMPA Sub Q About 800 health workers were trained to administer DMPA Sub Q and to train other health workers • Home/self-injection (H/SI) just starting to roll out: H/SI piloted outside a research setting (began in October 2016) in one district and we will be rolling out to 2 more districts in 2017. • PATH to test different approaches for optimal self-injection program starting Q2 2017.

  3. Why explore home/self-injection? What did women say about the H/SI feasibility study? • “It is secretive, it does not consume money, and it does not waste time.” • “It saves time of waiting at the hospital for a provider. I overcome missing my dose due to stockout because with this, I keep my medicine with me.” • “Saves me from movement every three months to the hospital; I will do my farm work without interference.” • “I don't need to travel long distance. It is easy, safe, and gives me the freedom to manage it myself” What did we find? In 2015, PATH/MOH self-injection feasibility and acceptability research found that nearly 90% of women trained to self-inject could do so competently and 98% wished to continue. PATH/Will Boase

  4. What should countries consider regarding advancing H/SI? • Government support is key • Availability of DMPA-SC stock in the country • Effective/good distribution system • Approved training curriculum by MoH • Policies permitting provision of DMPA-SC and DMPA-IM through CBD, in drug shops and pharmacies in the country • Optimal program components that are easy to scale up

  5. What’s next for policy development needed to increase access? • In regard to Home and Self Injection, currently Uganda has received a conditional approval from the National Drug Authority to update the product label—necessary but not sufficient • To move H/SI to national scale, a high-level policy authorization from the MOH HPAC will likely be required along with supportive “operational policies” (e.g., clinical guidelines on H/SI) Next steps for advocacy to expand access • Supportive policies for DMPA-SC access in general are also important • PATH worked with MOH to integrate DMPA -SC on the national EML (Essential Medical List) which implies that it will soon be distributed through the national distribution system • PATH is spearheading the process of integrating DMPA-SC in HMIS

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