Introduction of Long Acting Reversible Contraception (LARC) in a Clinical Trial Setting in Kwazulu-Natal

Abstract

Background: Although debatable recent studies have shown a possible increased risk of HIV acquisition with injectable hormonal contraception. In KwaZulu-Natal (KZN) the epicenter of the HIV epidemic injectable contraception is widely used. Based on the recommendation by the World Health Organization (WHO) to increase contraceptive options the Microbicide Trials Network (MTN) formed a Contraceptive Action Team (CAT) tasked to improve the contraceptive options at MTN research sites. As part of this initiative the Medical Research Council (MRC) Clinical Research Sites (CRSs) embarked on a drive to provide Intrauterine Devices (IUDs) and implants at the CRSs. Methods: Challenges included lack of LARC knowledge; myths and misconceptions about LARC participant fears about partner objection and LARC side effects; preference to remain on current method provision of training to clinical staff and accessing LARC. Strategies used included: community education and awareness conducted during community meetings and outreach campaigns; ongoing training provided to clinical staff on LARC insertions in collaboration with the KZN Department of Health (DoH); accessing of LARC from private suppliers and current negotiation with DoH; counselling and education on LARC during waiting room discussions at the CRSs and individual contraception counselling sessions. At these discussions participant fears about partner objection and fear of side effects of LARC were also addressed. Results: We have received positive feedback from the wider community regarding LARC. Community programmes ensure that myths and misconceptions about LARC are dispelled. Clinical staff have been trained on insertion of LARC at three CRSs. Conclusions: The CAT initiative has been successful in introducing and implementing LARC within the MRC CRSs in KZN. Despite this ongoing efforts are still required to increase the number of clinical staff trained on IUD and implant insertions at the CRSs and to increase the utilisation of LARC.