scholarly journals Developing acceptable contraceptive methods: Mixed-method findings on preferred method characteristics from Burkina Faso and Uganda

2019 ◽  
Vol 3 ◽  
pp. 1205
Author(s):  
Aurélie Brunie ◽  
Rebecca L. Callahan ◽  
Amelia Mackenzie ◽  
Simon P.S. Kibira ◽  
Madeleine Wayack-Pambè
Keyword(s):  
Side Effects ◽  
Burkina Faso ◽  
Unmet Need ◽  
User Preferences ◽  
Product Characteristics ◽  
Group Discussions ◽  
Pelvic Exam ◽  
Ranking Exercise ◽  
One Year ◽  
Long Acting

Background: Unmet need remains high in developing regions. New contraceptive technologies may improve uptake and use. This study examines desirable product characteristics. Methods: We added a module to the female questionnaire of the PMA2020 surveys in Burkina Faso and Uganda and conducted 50 focus group discussions (FGDs) with women, 10 FGDs with men, and 37 in-depth interviews (IDIs) with providers across the two countries. FGDs with women and IDIs with providers included a semi-structured ranking exercise on pre-selected product characteristics. Results: Effectiveness, duration, few side effects, cost, and access were the characteristics most commonly reported as important in choosing a method by survey respondents across both countries. Half or more of women surveyed in each country would like a method that lasts at least one year, while 65% in Burkina Faso and 40% in Uganda said they would use a method causing amenorrhea. Qualitative findings show that women want methods with minimal and predictable side effects. Reactions to increased bleeding were negative, especially in Burkina Faso, but perspectives on reduced bleeding were more mixed. Women and providers preferred methods that are discreet and not user-dependent, and associate duration with convenience of use. Some women in Uganda expressed concerns about the invasive nature of long-acting methods, and cost was an important consideration in both countries. In the ranking exercise, discreet use and few side effects often ranked high, while causing amenorrhea and not requiring a pelvic exam often ranked low. Conclusion: Product development should consider user preferences for success in these settings.

scholarly journals Developing acceptable contraceptive methods: Mixed-method findings on preferred method characteristics from Burkina Faso and Uganda

2019 ◽  
Vol 3 ◽  
pp. 1205 ◽  
Author(s):  
Aurélie Brunie ◽  
Rebecca L. Callahan ◽  
Amelia Mackenzie ◽  
Simon P.S. Kibira ◽  
Madeleine Wayack-Pambè
Keyword(s):  
Side Effects ◽  
Burkina Faso ◽  
Unmet Need ◽  
User Preferences ◽  
Product Characteristics ◽  
Group Discussions ◽  
Pelvic Exam ◽  
Ranking Exercise ◽  
One Year ◽  
Long Acting

Background: Unmet need remains high in developing regions. New contraceptive technologies may improve uptake and use. This study examines desirable product characteristics. Methods: We added a module to the female questionnaire of the PMA2020 surveys in Burkina Faso and Uganda and conducted 50 focus group discussions (FGDs) with women, 10 FGDs with men, and 37 in-depth interviews (IDIs) with providers across the two countries. FGDs with women and IDIs with providers included a semi-structured ranking exercise on pre-selected product characteristics. Results: Effectiveness, duration, few side effects, cost, and access were the characteristics most commonly reported as important in choosing a method by survey respondents across both countries. Half or more of women surveyed in each country would like a method that lasts at least one year, while 65% in Burkina Faso and 40% in Uganda said they would use a method causing amenorrhea. Qualitative findings show that women want methods with minimal and predictable side effects. Reactions to increased bleeding were negative, especially in Burkina Faso, but perspectives on reduced bleeding were more mixed. Women and providers preferred methods that are discreet and not user-dependent, and associate duration with convenience of use. Some women in Uganda expressed concerns about the invasive nature of long-acting methods, and cost was an important consideration in both countries. In the ranking exercise, discreet use and few side effects often ranked high, while causing amenorrhea and not requiring a pelvic exam often ranked low. Conclusion: Product development should consider user preferences for success in these settings.

Reasons to choose a long acting antipsychotic and tolerability

2017 ◽  
Vol 41 (S1) ◽  
pp. s822-s822
Author(s):  
I. Martínez Molina ◽  
N. Gómez-Coronado Suárez de Venegas ◽  
P. Blanco Ramón
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Negative Symptoms ◽  
Descriptive Analysis ◽  
Hypertensive Crisis ◽  
Antipsychotic Treatment ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
Positive And Negative Symptoms

IntroductionAripiprazole depot is an atypical antipshycotic used to treat positive and negative symptoms of psychosis or acute mania.AimDescribe the reason why psychiatrists switch the current antipsychotic treatment on to aripiprazol depot, its tolerability and the reasons to stop aripiprazol depot treatment.MethodsDescriptive analysis based on a sample of 37 patients, aged 18–65 years, treated during one year with antipsychotics at two community mental health units.ResultsSwitching on to aripiprazole depot principal reasons: promote adherence (25%), persistence of symptoms (25%) and high levels of prolactin or sexual dysfunction (16.66%):– side effects of aripiprazole depot: insomnia (11.11%), inquietude (8.33%), sexual dysfunction (2.77%) and hypertensive crisis during administration (2.77%);– 83.33% of the patients are still taking it after one year. The most common reasons to stop or change it were the presence of secondaries (11.11%) and clinical exacerbation (5.55%).ConclusionsAripiprazole depot is well tolerated (even better than other antipsychotics). Common side effects are not severe and appear in a small percent of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Study of depot medroxyprogesterone acetate as an extended postpartum contraceptive at SCB medical college and hospital, Cuttack

2021 ◽  
Vol 10 (4) ◽  
pp. 1484
Author(s):  
Sagarika Samal ◽  
Lucy Das
Keyword(s):  
Side Effects ◽  
Infant Mortality ◽  
Medroxyprogesterone Acetate ◽  
Contraceptive Use ◽  
Age Groups ◽  
Socioeconomic Group ◽  
Medical College ◽  
Unwanted Pregnancies ◽  
One Year ◽  
Long Acting

Background: Increase in contraceptive use during the postpartum period substantially reduces the rate of maternal and infant mortality by preventing unplanned and unwanted pregnancies. Injectable Medroxy Progesterone acetate (DMPA) is one long acting reversible safe and effective method for postpartm contraception. Aims and Objectives to study the acceptance, efficacy, side effects and compliance of DMPA as an extended postpartum contraceptive at SCB Medical College, Cuttack.Methods: The study includes 76 women between 6weeks to 1year postpartum who had chosen DMPA as contraceptive after counseling regarding the basket of choices. DMPA injection was given within 7 days of menstruation if it has returned or at any time after being confirmed that woman is not pregnant with a back up for first 7days. Subsequent injections were given at three monthly intervals and followed up for one year after the first injection for pregnancy rate, side-effects, discontinuation and patient satisfaction.Results: Maximum females were from the combined age groups 25-29 (39.47%) and 20-24 years (35.52%). 46.1% women belong to lower middle socioeconomic group. The most common menstrual problem was amenorrhea in 47.36% followed by scanty bleeding in 22.36%. 25% discontinued after 1st dose of injection, which is the maximum. The commonest reason for discontinuation observed was menstrual problems (37.93%) followed by use of other methods of contraception (17.24%). Out of 76, 23 women were not satisfied (30.26%), main reason of dissatisfaction being menstrual problems. Failure rate was nil.Conclusions: The study concludes that DMPA is a very effective, safe, and long acting contraceptive with no effect on lactation. Proper counseling can improve the acceptance and compliance.

scholarly journals Contraceptive Method Information and Method Switching in India

2021 ◽  
Vol 13 (17) ◽  
pp. 9831
Author(s):  
Md. Juel Rana ◽  
Srinivas Goli ◽  
Rakesh Mishra ◽  
Abhishek Gautam ◽  
Nitin Datta ◽  
...  
Keyword(s):  
Side Effects ◽  
Multinomial Logistic Regression ◽  
Unmet Need ◽  
Family Health ◽  
Informed Choice ◽  
Contraceptive Methods ◽  
The Sustainable Development ◽  
Comprehensive Method ◽  
Contraceptive Discontinuation ◽  
Long Acting

The stagnation in the unmet need for family planning and rise in contraceptive discontinuation rates are major concerns among researchers and policymakers in India. This study attempts to investigate the association between method information received by the users at the time of initiation and the switching of contraceptive methods in India. Using the fourth round of National Family Health Survey (NFHS) data (2015–2016), a multinomial logistic regression model has been applied to assess the net effects of method information received by the users on switching of contraceptive methods. The reuse of contraceptive methods is higher among those who were not provided any method information. The reuse is also higher among those who were informed only about the side effects. Overall, the users who received comprehensive method information are more likely to switch. Particularly, the users who were informed about how to manage side effects either alone or along with other method information have a higher likelihood of switching especially to long-acting reversible contraceptives (LARC). The findings call for program intervention to provide comprehensive method information to the users because it gives them the freedom to switch to more suitable methods. Thus, it would help in achieving the sustainable development goal (3.7) of informed choice of contraceptive methods.

Effect in antipsychotic-induced hyperprolactinemia after switching to long-acting injectable aripiprazole: A 1-year study

2017 ◽  
Vol 41 (S1) ◽  
pp. s815-s816
Author(s):  
M. Juncal Ruiz ◽  
B. Fernández-Abascal Puente ◽  
O. Porta Olivares ◽  
M. Gómez Revuelta ◽  
R. Landera Rodríguez ◽  
...  
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Clinical Improvement ◽  
Drug Induced ◽  
Oral Olanzapine ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
Almost All

IntroductionAntipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.AimsTo evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.MethodsThis was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.ResultsIn basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.ConclusionsSeveral studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals 883. Qualitative Patient-Participant Perspectives on Implementation of Monthly Cabotegravir and Rilpivirine Long Acting (CAB+RPV LA) Injectable in the United States (CUSTOMIZE)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S533-S533
Author(s):  
Cindy Garris ◽  
Larissa Stassek ◽  
Ronald D’Amico ◽  
Marybeth Dalessandro ◽  
Sheila Adkins ◽  
...  
Keyword(s):  
Side Effects ◽  
The United States ◽  
Hiv Treatment ◽  
Early Implementation ◽  
Patient Participant ◽  
One Year ◽  
Long Acting ◽  
Hiv Status Disclosure ◽  
Participant Perspectives ◽  
Status Disclosure

Abstract Background CAB+RPV LA administered monthly for HIV treatment is non-inferior to daily oral ART at maintaining viral suppression and preferred by most participants in clinical trials over daily ART. CUSTOMIZE, an implementation-effectiveness study, evaluated facilitators and barriers to clinic implementation of CAB+RPV LA from the patient perspective. Methods 115 participants were enrolled across 8 HIV clinics. Semi-structured phone interviews were conducted with a randomized subgroup of 3-6 participants per site, prior to the 1st (Baseline [BL], N=34) and 12th CAB+RPV LA injections (Month 12 [M12], N=31). Consolidated Framework for Implementation Research-guided interviews were recorded, transcribed, and coded using ATLAS.ti. Results At BL, 97% (n=33) of those interviewed indicated ≥1 challenge taking daily oral ART, including concerns about adherence (n=19; 56%), dosing frequency (n=13; 38%) and side effects (n=12; 35%). Twenty-seven (79%) reported anticipated challenges of CAB+RPV LA such as worry about side effects (n=15; 44%) and discomfort from injections (n=14; 41%). Participants reported at BL that CAB+RPV LA may help with adherence (n=17; 50%) or reduce fears of HIV status disclosure (n=10; 29%). At M12, 35% (n=11) reported some pain/discomfort from injections, but 87% (n=27) reported satisfaction with CAB+RPV LA, most commonly due to preferring the monthly regimen over the daily pill (n=15; 48%). Facilitators reported by participants as most helpful during early implementation were verbal education by clinic staff (14%), reminder texts/calls (13%), and an educational video about the regimen (6%). Most (n=25; 81%) indicated clinic hours were not a barrier, but 19% (n=6) noted taking time off work for the visits. Many participants (n=21; 68%) described positive aspects of going to the clinic each month, none complained about visit length, and 94% (n=29) reported intent to continue CAB+RPV LA after the study. Conclusion Interviewed participants reported several challenges with daily oral ART that monthly CAB+RPV LA may help overcome. Some initial concerns about receiving CAB+RPV LA were reported at BL, but most participants were satisfied with the regimen after one year and plan to continue receiving CAB+RPV LA following the study. Disclosures Cindy Garris, MS, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Larissa Stassek, MPH, GlaxoSmithKline (Consultant, Other Financial or Material Support, My company (Evidera) received funding from GSK to conduct this research. We did not receive funding for work on this abstract.) Ronald D’Amico, DO, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Marybeth Dalessandro, BS, ViiV Healthcare (Employee, Shareholder) Sheila Adkins, BS, GSK (Employee)GSK (Employee, Stock) Maggie Czarnogorski, MD, MPH, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)

scholarly journals A retrospective analysis on acceptability and complications of PPIUCD insertion

2018 ◽  
Vol 7 (11) ◽  
pp. 4536
Author(s):  
Prabha Lal ◽  
Nihita Pandey ◽  
Abha Singh
Keyword(s):  
Family Planning ◽  
Post Partum ◽  
Tertiary Care ◽  
Unmet Need ◽  
First Year ◽  
Care Hospital ◽  
Population Crisis ◽  
One Year ◽  
Long Acting

Background: In India, 65% of women in the first year postpartum have an unmet need for family planning but only 26% of women are using any method of family planning during the first year postpartum. This leaves a huge gap which needs to be addressed if maternal health is to be optimized. This calls for a method which is both effective and acceptable immediately post-partum. This is where the role of PPIUCD needs to be studied.Methods: This study was a retrospective observational study conducted in a tertiary care hospital. All deliveries during the time period from September 2016 to August 2017 were included in the study and the women accepting PPIUCD were studied for analysed for their age, parity, booking status and complaints during the follow up visit.Results: A total of 13,039 deliveries took place in one year between Sept 2016 to Aug 2017 out of which, 1118 (8.6%) accepted PPIUCD as a method of contraception. 44.3% PPIUCD users were in the age group of 21-25 years. 57% of PPIUCD users were primigravidas. 84% of PPIUCD users were booked cases. Missing threads was the most common complication, with 8.4% patients reporting it at follow up. There were no major complications noted in the study.Conclusions: PPIUCD is a safe and effective long acting reversible contraception method. Is particularly beneficial in a setting where women do not return for contraceptive advice. With low expulsion rates and high continuation rate, authors can conclude that PPIUCD can be the solution to a country like India currently facing population crisis and high unmet need.

Postpartum women’s knowledge and planned use of contraception in Myanmar

2020 ◽  
pp. bmjsrh-2020-200686
Author(s):  
Hnin Hnin Yu ◽  
Camille Raynes-Greenow ◽  
Kyi Kyi Nyunt ◽  
Santhar Hnin Htet ◽  
Nan Kin Wutt Yee ◽  
...  
Keyword(s):  
Side Effects ◽  
Unmet Need ◽  
Contraceptive Methods ◽  
Policy And Practice ◽  
Cross Sectional Survey ◽  
Postpartum Contraception ◽  
Cross Sectional ◽  
Major Barrier ◽  
Long Acting ◽  
Unmet Need For Contraception

BackgroundMaternal mortality in Myanmar is one of the highest in the WHO South-East Asian region. Additionally, the country has a high unmet need for contraception and low rates of uptake of long-acting reversible contraceptive methods (LARCs) including intrauterine devices (IUDs) and implants. Engagement with health professionals around the time of a birth is an ideal opportunity for women to access contraception but immediate postpartum provision is not widely offered in Myanmar.MethodsWe undertook a cross-sectional survey of women immediately postpartum at two hospitals in Yangon to investigate their knowledge, and past use of, contraceptive methods and their plans for postpartum contraception including perceptions of implants and IUDs. Four trained obstetrics staff collected data using electronic tablets between January 2017 and January 2018.ResultsOf the 1755 participants, 55.1% had used pills and 42.2% injectables. In contrast, only 0.5% had used an IUD and 0.3% an implant. Few women (4.4%) anticipated starting contraception immediately postpartum and only a minority would consider future use of an implant (36.9%) or an IUD (13.0%). Fear of side effects was the major barrier to future implant and IUD uptake, reported by 64.5% and 62.5%, respectively.ConclusionsWomen in maternity care in Yangon have some awareness of IUDs and implants but many hold misconceptions about their side effects leading to reluctance to use. Reducing the unmet need for contraception and improving maternal outcomes in Myanmar could be achieved by improving education, policy and practice around immediate postpartum contraception provision, with a particular focus on LARC methods.

CLINICAL INVESTIGATIONS OF A LONG-ACTING OESTRIOL (POLYOESTRIOL PHOSPHATE)

1961 ◽  
Vol 38 (1) ◽  
pp. 73-87 ◽  
Author(s):  
Christian Lauritzen ◽  
Semih Velibese
Keyword(s):  
Side Effects ◽  
Phosphoric Acid ◽  
Quantitative Data ◽  
Water Soluble ◽  
Cholesterol Concentration ◽  
Experimental Investigations ◽  
Clinical Investigations ◽  
Prolonged Duration ◽  
High Doses ◽  
Long Acting

ABSTRACT A description is given of experimental investigations and preliminary clinical experience with the long-acting oestriol compound polyoestriol phosphate – a water-soluble polymere of oestriol and phosphoric acid. The compound seems to exert all the physiologically important effects of oestriol. Even with high doses the hormone causes no proliferation of the endometrium and no withdrawal bleeding. It has no untoward effect on metabolism. It decreases slightly the cholesterol concentration (to the extent of ⅓–⅕ of the effect produced by long-acting oestradiol esters). The compound has a wide therapeutic range. No side-effects have been observed. Doses of 10 mg or more have a prolonged duration. Additional prolongation of the effect is largely dependent on dosage. To ensure an effect lasting for 4 weeks 40 mg polyoestriol phosphate (corresponding with 30 mg oestriol) is required – an amount which roughly corresponds with physiological quantitative data. The compound, which involves an interesting new principle of prolongation, was most effectively used in the treatment of menopausal symptoms and genital organic disorders. For these indications it can be recommended without reservation.

scholarly journals A qualitative study to identify critical attributes and attribute-levels for a discrete choice experiment on oral pre-exposure prophylaxis (PrEP) delivery among young people in Cape Town and Johannesburg, South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Janan J. Dietrich ◽  
Millicent Atujuna ◽  
Gugulethu Tshabalala ◽  
Stefanie Hornschuh ◽  
Mamakiri Mulaudzi ◽  
...  
Keyword(s):  
South Africa ◽  
Young People ◽  
User Preferences ◽  
Dosing Regimen ◽  
Group Discussions ◽  
On Demand ◽  
Study Team ◽  
Attribute Levels ◽  
Depth Interviews ◽  
Oral Prep

Abstract Background The uptake and adherence of daily oral PrEP has been poor in high-risk populations in South Africa including young people. We used qualitative research methods to explore user preferences for daily and on-demand oral PrEP use among young South Africans, and to inform the identification of critical attributes and attribute-levels for quantitative analysis of user preferences, i.e. a discrete choice experiment (DCE). Methods Data were collected between September and November 2018 from eight group discussions and 20 in-depth interviews with young people 13 to 24 years in Cape Town and Johannesburg. Using a convenience sampling strategy, participants were stratified by sex and age. Interviewers used a semi-structured interview guide to discuss several attributes (dosing regimen, location, costs, side effects, and protection period) for PrEP access and use. Group discussions and in-depth interviews were audio-recorded, transcribed verbatim and translated to English. We used framework analysis to explore context-specific attributes and attribute-levels for delivering oral PrEP in South Africa. The adolescent community advisory board, expert and study team opinions were consulted for the final DCE attributes and levels. Results We enrolled 74 participants who were 51% (n = 38/74) male, had a median age of 18.5 [Interquartile range = 16–21.25] years, 91% (n = 67/74) identified as heterosexual and 49% (n = 36/74) had not completed 12th grade education. Using the qualitative data, we identified five candidate attributes including (1) dosing regimen, (2) location to get PrEP, (3) cost, (4) route of administration and (5) frequency. After discussions with experts and the study team, we revised the DCE to include the following five attributes and levels: dosing regime: daily, and on-demand PrEP; location: private pharmacy, public clinic, mobile clinic, ATM); cost: free-of-charge, R50 (~2GBP), R265 (~12GBP); side effects: nausea, headache, rash; and duration of protection: fulltime protection versus when PrEP is used). Conclusions There is limited literature on qualitative research methods describing the step-by-step process of developing a DCE for PrEP in adolescents, especially in resource-constrained countries. We provide the process followed for the DCE technique to understand user preferences for daily and on-demand oral PrEP among young people in South Africa.

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