1. Experience with DMPA-SC: Delivery Points – Part Two
Dr. Bagrey Ngwira, University of Malawi
Tuesday, January 31, 2017
COLLEGE OF MEDICINE

2. Malawi home and self-injection (HSI) study
Malawi’s first experience with Sayana® Press: lays groundwork for national introduction of Sayana Press and scale-up of HSI
Answers whether HSI improves continuation rates
Provides evidence on the safety and feasibility of community-based provision of injectables for HSI
Sample size 700+ adult women seeking FP services; study will be completed by mid-2017
Research Question: Do continuation rates differ between women who self-inject Sayana® Press (SP) as compared to those receiving SP injected by a provider, including community health workers (CHWs)?
Approach
One-year, prospective randomized clinical trial with 700+ adult women seeking family planning services, randomized to:
Receive SP from a provider (including CHWs), or
Receive training on SP self-injection and product to self-inject at home
Quarterly visits after each re-injection date to assess continuation rates, acceptability, adverse events, and pregnancy
Qualitative component: 30 self-injectors & 12 providers
Impact
Inform decision-making for procurement and distribution in Malawi
Inform global guidelines on self-injection; provide evidence on safety and feasibility of community-based provision of injectables for HSI; inform self-injection training materials and messaging for clients and providers

3. Key FP Stakeholders in Malawi
National
MOH Reproductive Health Dept.
Safe Motherhood Technical Working Group (TWG)
Family Planning Sub TWG
District
District Exec. Committee
MOH District Health Management Team headed by DHO
Community
Traditional Authority
Group Village Head Men
Village Head Men
Village Health Committee
Safe Motherhood TWG consists of all MCH partners and is coordinated by the MOH RH Department.
FP sub-TWG consists of FP partners and UNFPA who procures methods for Malawi.
To reach community members with information about the RCT we conducted community awareness meetings that began with a drummer group and discussion about health theme.

4. What should countries consider?
Engage stakeholders early and often
Key questions from Malawi stakeholders:
How will men be engaged?
Why conduct the RCT in Mangochi District?
How will used SP units be disposed of in community?
Incorporated feedback into study design and implementation
Key questions from Malawi family planning stakeholders:
How will men be engaged?
Through community level engagement (community sensitization meetings prior to study launch)
Why conduct the RCT in Mangochi District?
Rural, fewer resources for FP  High potential benefit from HSI
Established CHWs  RCT will provide evidence on safety and feasibility of community-based provision of injectables for HSI
How will used SP units be disposed of in community?
Disposal in pit latrine against Malawi’s waste management policy which requires all sharps be incinerated
Stakeholders approved disposal in pit latrines for RCT

5. What’s next for policy development to increase access?
Engage key stakeholders in interpretation and analysis prior to broader dissemination
Disseminate findings and seek endorsement from MOH and national stakeholders
Engage Waste Management Team to change disposal policy
We can accomplish this through one-on-one meetings with the key stakeholders at MOH. Go through the slide deck of findings and discuss them and they may have questions or additional analysis they want done. This fosters ownership prior to the broader dissemination.
Waste Management Team is located in the MOH’s Environmental Health Department

6. For More information
Holly Burke, Principal Investigator
Bagrey Ngwira, Site Investigator