Table 1

Study descriptions

CitationStudy location and population characteristicsStudy designIntervention descriptionComparison group description
Beasley et al11New York City, USA.
Women aged 18+ seeking DMPA for contraception.
Mean age (±SD): (I) 26.0±6.1; (C) 26.1±6.3.
Randomised controlled trial.
132 participants (86 self-administration, 46 clinic administration).
12-month follow-up.
Self-administration of DMPA-SC.
Participants were taught to self-inject Depo-SubQ Provera 104 by the study coordinator. The participant performed the initial injection in the abdomen or thigh under supervision, and if deemed acceptable was given prepackaged DMPA-SC containing a prefilled syringe and needle to use at home, along with alcohol pads, a bandage, a urine pregnancy test and a calendar with dates for the next injection. Each participant received a sharps disposal canister and instructions on safe needle disposal. At the 6-month visit, those in the self-administration group were re-evaluated for ability to self-inject and received additional prepackaged DMPA-SC for home administration.
Clinic administration of DMPA-SC.
Participants received routine appointments for their next injections (every 3 months).
Burke et al12Mangochi District, Malawi.
Women aged 18–40 years old receiving family planning services.
Mean age: 26.9 years (SD: 5.21).
Randomised controlled trial.
731 participants (364 self-administration, 367 provider administration).
12-month follow-up.
Self-administration of DMPA-SC.
All women received DMPA-SC injections in the form of Sayana Press 104 mg in a 0.65 mL suspension. Women who successfully self-injected at enrolment were given three doses of DMPA-SC to take home for subsequent self-injections and written instructions to remind them of the injection procedures. Participants could also ask the provider to train a trusted person to give them DMPA-SC at home. At enrolment, women were provided with a written note showing their future injection dates (every 13 weeks) and a calendar to assist them in remembering when to reinject.
Provider administration of DMPA-SC.
At enrolment, women were provided with a written note showing their future injection dates (every 13 weeks) and a calendar to assist them in remembering when to return for reinjection.
Cameron et al, 201213Edinburgh, Scotland.
Women aged 18–40 years old attending family planning clinic and existing users of DMPA-IM for at least 9 months.
Mean age: (I) 29.2 years (SD: 5/0); (C) 28.8 (SD: 5.6).
Controlled cohort study.
128 participants (64 self-administration, 64 provider administration).
12-month follow-up.
Self-administration of DMPA-SC.
Women were taught how to give a subcutaneous injection (Sayana) by the study research nurse. When deemed competent in the technique, they gave themselves the initial self-injection of DMPA-SC into their abdomen under nurse supervision at the clinic. Women were provided with three prefilled syringes of DMPA-SC, together with needles for subcutaneous injection, to take home and a list of dates when the three injections would be due. Women were also given a pack containing written information on the method of self-injection, advice on safe storage of the medicine and safe disposal of the needles (including a small ‘sharps’ disposal box) and 24-hour contact telephone numbers for advice. Women were sent a text message 1 week prior to the scheduled date of injection to remind them when the next injection was due.
Provider administration of DMPA-IM.
No reminders were sent.
Cover et al155 districts in Uganda.
Women aged 18–45 years old attending participating health facilities for routine FP visits who expressed an interest in using injectable contraception (whether new, continuing or past injectable users).
Mean age: (I) 26.9 (SD: 6.4); (C) 26.5 (SD: 6.2).
Controlled cohort study.
1161 participants (561 self-administration, 600 provider administration).
12-month follow-up.
Self-administration of DMPA-SC.
Those who opted for self-injection were trained one-on-one and administered their first injection under the supervision of a study nurse. They were given an instruction booklet, reinjection calendar and three units to take home.
Clinic administration of DMPA-IM.
Women who opted for DMPA-IM received their first injection from a study nurse, were instructed to return in 3 months and were given an appointment card.
Cover et al14Dakar and Thiés regions of Senegal.
Women aged 18–45 years old attending participating health facilities for routine FP visits who expressed an interest in using injectable contraception (whether new, continuing or past injectable users).
Mean age: (I) 26.9 (SD: 6.4); (C) 26.5 (SD: 6.2).
Controlled cohort study.
1299 participants (650 self-administration, 649 provider administration).
12-month follow-up.
Self-administration of DMPA-SC.
Women were trained individually and their self-injection technique was evaluated for competency. Those judged competent were given three DMPA-SC units, an instruction booklet and a reinjection calendar. Those not competent were asked to return at the time of their second injection for refresher training, at which time their competency was reassessed and, if competent, they were given self-injection supplies.
Clinic administration of DMPA-IM.
The DMPA-IM group received injections at the clinic and were given appointment cards to return for future injections.
Kohn et al5Texas and New Jersey, USA.
Women ages 15–44 requesting DMPA, including method initiators and continuers.
Age range: 16–44 (mean: 26 years).
Randomised controlled trial.
400 participants (200 self-administration, 200 provider administration).
12-month follow-up.
Self-administration of DMPA-SC.
Women were taught to self-inject using printed instructions based on the drug packaging insert. If willing, participants then self-administered DMPA-SC under staff supervision. Those who correctly self-administered received three additional doses of DMPA-SC, a self-administration kit (including alcohol swabs, cotton pads, bandages, mini sharps disposal container) and printed self-administration instructions for the subsequent three injections, along with a calendar showing the appropriate injection dates. Participants received a reminder email and/or text message 2 weeks before each injection was due.
Clinic administration of DMPA-SC.
Participants were administered DMPA-SC by qualified clinic personnel.
Participants received a reminder email and/or text message 2 weeks before each injection was due.
  • C, control; DMPA, depot medroxyprogesterone acetate; DMPA-IM, DMPA intramuscular product; DMPA-SC, DMPA subcutaneous product; I, intervention.