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

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. Note Pathfinder, FHI 360, WellShare International, RHU were also important partners in the introduction.

Why explore home/self-injection? PATH/Will Boase 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. Self-Injection is important because a number of barriers that affect the uptake of FP are overcome: transport costs, long distances to the health facilities, time, health worker attitudes, stock outs, and confidentiality especially among adolescents. 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.

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

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 Maybe note that PATH has aligned with CHAI who is working on this