Abstract
BackgroundThe use of implants has steadily increased in Kinshasa since 2013 but clinic-based access to this family planning method is limited due to distance and costs barriers. The objective of this study was to examine the feasibility and acceptability of providing Implanon NXT at the community level using medical and nursing students (M/N) as distributors, as part of a strategy to improve contraceptive uptake in the Democratic Republic of Congo.MethodsA cohort of 531 women who chose to receive Implanon NXT from a M/N student during community-based campaign days participated in three rounds of a quantitative survey administered at the time of insertion of the method, and at 6 and 12 months later. We conducted descriptive analysis to assess the feasibility and acceptability of providing the method through M/N students in terms of method choice, user profiles, contraceptive history, experience with insertion and side effects, continuation / discontinuation of the method, and overall satisfaction with FP services as well as students’ preparedness and capacity to safely offer the method, and their satisfaction with the experience..ResultsThe study demonstrated the feasibility of training students for community-based provision of Implanon NXT and 95% of them were satisfied with their experience. Acceptability of both the method and the service delivery strategy was high among participants, including among young and first-time contraceptive users. Out of the 441 women with a known outcome at 12 months, 92% still had Implanon NXT inserted, despite some of them reporting experiencing side effects. The vast majority (79%) would “strongly recommend” obtaining NXT from a M/N student if a friend wanted to avoid pregnancies.ConclusionsThe provision of Implanon NXT at the community-level is a promising solution to address some of the barriers to accessing this method for women living in Kinshasa. However, strengthening pre-insertion counseling, particularly on expected side-effects and the possibility of early removal, is necessary to increase informed choice for the women and potentially limit method discontinuation.
Highlights
The use of implants has steadily increased in Kinshasa since 2013 but clinic-based access to this family planning method is limited due to distance and costs barriers
Despite community-based provision of Family Planning (FP) services being a keystone of the National Strategic Plan for Family Planning (2014–2020) [9], the Ministry of Health does not permit the use of non-formally trained health workers for provision of contraceptives other than pills, condoms and Cyclebeads
In 2017, the introduction in Democratic Republic of Congo (DRC) of Implanon NXT (NXT), a new model of single-rod implant developed by Merck Sharp & Dohme (MSD) and preloaded in a disposable applicator [12], in combination with the potential of using medical and nursing students (M/N) students to provide contraceptives, created the opportunity to pilot the provision of the new method by this cadre
Summary
The use of implants has steadily increased in Kinshasa since 2013 but clinic-based access to this family planning method is limited due to distance and costs barriers. In countries where contraceptive prevalence remains low and access to facility-based healthcare is difficult because of costs, transportation or health systems weaknesses, task-shifting the provision of family planning services to lower cadre of health workers (i.e. not doctors or nurses) operating at the community level has proven successful in a variety of settings [1, 2]. In 2015 a pilot project leveraged one exception to that rule and successfully tested the feasibility and acceptability of using medical and nursing school (M/N) students to provide DMPA-SC at the community level [10] These positive evaluations sparked new opportunities for task-shifting in DRC, with a particular emphasis on the potential of using M/N students in communitybased provision of FP services [11]. In 2017, the introduction in DRC of Implanon NXT (NXT), a new model of single-rod implant developed by MSD and preloaded in a disposable applicator [12], in combination with the potential of using M/N students to provide contraceptives, created the opportunity to pilot the provision of the new method by this cadre
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