Self-administration of subcutaneous depot medroxyprogesterone acetate contraceptive is a “feasible and acceptable” alternative to clinic-based administration, according to a study published online Dec. 12 in Contraception.
Researchers randomized 401 women aged 15-44 years – who had requested depot medroxyprogesterone acetate – to four injections over the year, administered by clinic staff at one of three Planned Parenthood health centers or self-administered at home.
The self-administered group performed the first injection at the clinic under supervision, then received instructions and three doses for home use.
At the 12-month follow-up, the rates of continuous use of the contraceptive – defined as reporting two additional doses on the 6-month survey and at least one additional dose on the 12-month survey – were 69% in the self-administration group and 54% in the clinic group (P = .005).
A significantly greater proportion of women in the self-administration group reported receiving at least four shots over the study period, compared with the clinic administration group (78% vs. 64%; P = .008). The authors also noted that 64% of the self-administration group reported receiving five doses – an additional poststudy shot – compared with 52% of the clinic group.
The self-administered injection was well received by women in that group, with 97% saying it was very or somewhat easy to administer, and 87% saying they would recommend self-injection to a friend.
Around half of the participants in the clinic group said they would be interested in self-administration in the future, but both groups reported similar levels of satisfaction with the injectable contraceptive overall.
“A survey study found that women who had difficulty obtaining or refilling a prescription in the past year were almost twice as likely to be interested in self-administration compared to those without such difficulty, suggesting that self-administration has potential to reduce barriers and disparities in access to effective contraception,” wrote Julia E. Kohn, PhD, MPA, and her colleagues at Planned Parenthood. “It is important to note, however, that potential barriers related to insurance coverage and reimbursement will need to be identified and addressed for self-administration to be successfully put into practice.”
There were three pregnancies. They were in the clinic group in women who had discontinued the contraceptive, and one was a planned pregnancy. There were two reports of pain and two reports of bruising at the injection site, but no serious adverse events were reported.
While the study relied on self-report of successful injections, the authors pointed to a recent study in which all women who reported self-injections had therapeutic levels of depot medroxyprogesterone acetate confirmed by blood testing.
Tara Health Foundation supported the study. Pfizer provided the study drug through an investigator-initiated research grant. No disclosures were made.
SOURCE: Kohn JE et al. Contraception. 2017 Dec 7. doi: 10.1016/j.contraception.2017.11.009