Subdermal Contraceptive Implants Research Articles

Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data

BackgroundSuccessful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services.MethodsAn implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals.ResultsLandscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals.ConclusionLandscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.

A 5-Year Audit of the Use of Sub-dermal Contraceptive Implants in a Teaching Hospital in Ekiti State, Nigeria

A 5-Year Audit of the Use of Sub-dermal Contraceptive Implants in a Teaching Hospital in Ekiti State, Nigeria

Social Media Videos on Contraceptive Implants: An Assessment of Video Quality and Reliability

There are many videos on contraception on YouTube and TikTok, and women around the world use video platforms extensively to seek health information from videos of uncertain reliability and quality. The main objective of this research was to evaluate the scientific reliability and quality of the most popular social media videos about contraceptive subdermal implants. TikTok and YouTube videos were assessed separately by two gynecologists. The video quality was evaluated according to the DISCERN score, modified DISCERN score, and Global Quality Scale (GQS) score. The study included the 100 most popular videos, 44 of which were uploaded by health care professionals. The median DISCERN score for videos shared by health care professionals was 50 (range 15-75), whereas it was 22 (range 15-56) for videos shared by independent users (P < .001). The median modified DISCERN score was 4 (min-max 0-5), and the median GQS score was 4 (min-max 1-5) for the videos uploaded by health care professionals. The modified DISCERN and GQS scores of TikTok videos were lower than those of YouTube videos (both P < .001). Social media videos about contraceptive subdermal implants are popular and have been viewed tens of thousands of times, but the overall medical validity, which we evaluated according to the scoring systems, was poor. Despite the large number of videos, the content's quality and reliability are quite limited. There is a need to prioritize the education provided to patients by gynecologists, as well as to create high-quality content for YouTube and other similar platforms.

Subdermal contraceptive implants and repeat teenage motherhood: Evidence from a major maternity hospital-based program in Uruguay.

Teenage fertility is a social problem because of its private and public costs in countries of different development levels. Reductions in adolescent birth rates do not necessarily follow drops in overall fertility due to the demographic transition model. This paper analyses the impact of a subdermal contraceptive program on repeat teenage motherhood. Using a regression discontinuity design, we find that the intervention reduced mothers' likelihood of having another child in the next 48months by 10 percentage points. This reduction is not random, and we also identify small positive selection in subsequent births.

Acceptability and continuation of use of the subdermal contraceptive implant among adolescents and young women in Argentina: a retrospective cohort study

A new public policy was instituted in Argentina for free distribution of subdermal contraceptive implants to women aged 15–24 years old in the public healthcare system. The objective of this study is to determine the extent to which this population adhered to the implant, as well as predictors of continuation. The retrospective cohort study was based on a telephone survey of a random sample of 1101 Ministry of Health-registered implant users concerning the continuation of use, satisfaction with the method and side-effects, and reasons for removal. Descriptive statistics and multivariate regression analysis were used to explore the association between adherence and having received contraceptive counselling, satisfaction, and side effects. We found high levels of adherence (87%) and satisfaction (94%). Common reported side effects were amenorrhoea or infrequent bleeding, perceived weight gain, increased menstrual bleeding and headaches. Multivariate regression analysis indicates that, among adolescents, having received contraceptive counselling increased comfort, while frequent bleeding at six months hindered trust. Participants who had a history of a prior delivery or who had themselves primarily chosen the method were less likely to request the removal of the implant. Our results support the public policy of free implant distribution in the public health sector. This is a sustainable public policy that contributes to equity and access to effective contraception. It is appropriate for adolescents and young women and will also reduce unintended pregnancies. Our results suggest that counselling patients is key prior to insertion of the implant, as it improves acceptability and continuation.

Satisfaction With the Use of Subdermal Contraceptive Implant in Women Attending the Specialized Polyclinic Primary Health Care Center in Jeddah City: A Cross-Sectional Study.

Background Subdermal contraceptive implants are a convenient method of contraception for many women due to the ease of insertion and removal and because they require less follow-up with their health facility. In addition to the contraceptive benefits, women's satisfaction with such devices is essential, as this can affect their quality of life. This study aims to measure women's satisfaction with the subdermal contraceptive implant, Implanon® (Organon & Co., Jersey City, New Jersey, United States), its main side effects, and reasons for removal. Methods A cross-sectional study was conducted on women between the ages of 19 and 65 years who visited the Family Planning Clinic at the Specialized Polyclinic Primary Health Care Center in Jeddah, Saudi Arabia, between January 2018 and December 2021. An online questionnaire was distributed to the women who had Implanon inserted and 84 responded. Demographic and contraceptive data were collected, including the dates of insertion and removal of Implanon and side effects experienced while on Implanon. Results Of the 84 women, 65.84% were satisfied with Implanon, while only 19.04% were unsatisfied with the implant. The most common side effect reported was weight gain (54.76%), followed by menstrual Irregularity. (39.29%). The most common reason for removal was the end of the implant's contraceptive duration (42.86%). Conclusion Most of the women treated at this primary healthcare clinic were satisfied with Implanon. In addition, most of the women removed the implant only due to its reaching the end of its contraceptive duration despite experiencing side effects, and most women said that they would recommend it to their family and friends.

Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries

This study aimed to estimate the proportion of health facilities without the capability to remove contraceptive implants and those that have the capability to insert them and to understand facility-level barriers to implant removal across 6 countries in sub-Saharan Africa. Using facility data from the Performance Monitoring for Action in Burkina Faso, the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, and Uganda from 2020, we examined the extent to which implant-providing facilities (1) lacked necessary supplies to remove implants, (2) did not have a provider trained to remove implants onsite, (3) could not remove deeply placed implants onsite, and (4) reported any of the above barriers to implant removal. We calculated the proportion of facilities that report each barrier, stratifying by facility type. Between 31% and 58% of implant-providing facilities reported at least 1 barrier to implant removal in each country (6 sub-Saharan African countries). Lack of trained providers was the least common barrier to implant removal (0%-17% of facilities), whereas lack of supplies (17%-44% of facilities) and the inability to remove a deeply placed implant (16%-42%) represented more common obstacles to removal. Blades and forceps were commonly missing supplies across all 6 countries. Barriers to implant removal were less commonly reported at hospitals than at lower-level facilities in all countries except Burkina Faso. This multicountry analysis showed that facility-level barriers to contraceptive implant removal are widespread among facilities that offer implant insertion. By preventing users from being able to discontinue their implants on request, these barriers pose a threat to contraceptive autonomy and reproductive health.

Pharmacokinetics of levonorgestrel and etonogestrel contraceptive implants over 48 weeks with rilpivirine- or darunavir-based antiretroviral therapy.

Pharmacokinetic data are lacking for progestin-releasing subdermal contraceptive implants when used with either rilpivirine- or darunavir/ritonavir-based ART. To characterize the pharmacokinetics of etonogestrel or levonorgestrel implants when administered with these ART regimens over 48 weeks. Two separate, parallel, three-group, non-randomized, pharmacokinetic studies evaluated either etonogestrel or levonorgestrel in women receiving rilpivirine- or darunavir-based ART compared with women without HIV (control group). Participants on ART were switched to rilpivirine-based ART with a run-in period of 6 weeks or darunavir-based ART with a run-in of 2 weeks prior to implant insertion. Plasma was collected on Day 0, and 1, 4, 12, 24, 36 and 48 weeks post-insertion. Plasma progestin concentrations were compared between ART and control groups by geometric mean ratio (GMR) and 90% CI. At the primary endpoint of Week 24, progestin concentrations were similar between the rilpivirine and control groups [etonogestrel: 1.18 (0.99-1.37); levonorgestrel: 1.16 (0.97-1.33)]. At Week 24, progestin exposure was higher in the darunavir groups compared with the control group [etonogestrel: 2.56 (1.69-3.28); levonorgestrel: 1.89 (1.38-2.29)]. Results remained consistent through to Week 48. No differences in etonogestrel-related adverse events were observed, but both ART groups experienced more menstrual abnormalities versus the control group with levonorgestrel. Etonogestrel and levonorgestrel concentrations were not altered by rilpivirine-based ART. Although progestin concentrations were higher in the ART groups containing ritonavir-boosted darunavir, no implant-related serious adverse events were observed. Both progestin-releasing implants are an appropriate contraceptive option with either rilpivirine- or darunavir/ritonavir-based ART.

Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case-Control Study.

PurposeEtonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case–control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution.Patients and MethodsWe identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest.ResultsA total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [−0.6, 14.7] kilograms versus 1.6 [−1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified.ConclusionWe did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.

EE176 Cost-Effectiveness of Etonogestrel Subdermal Contraceptive Implant (ESI) Compared to Levonorgestrel Intrauterine Device (LNG-IUD) Reimbursed on the Brazilian Private Health Insurance and Plans

EE176 Cost-Effectiveness of Etonogestrel Subdermal Contraceptive Implant (ESI) Compared to Levonorgestrel Intrauterine Device (LNG-IUD) Reimbursed on the Brazilian Private Health Insurance and Plans

EE76 Budget Analysis of Etonogestrel Subdermal Contraceptive Implant (ESI) Compared to Levonorgestrel Intrauterine Device (LNG-IUD) Reimbursed on the Brazilian Private Health Insurance and Plans

To estimate the budget analysis of Etonogestrel Subdermal Contraceptive Implant (ESI) Compared to Levonorgestrel Intrauterine device (LNG-IUD) Reimbursed on the Brazilian Private Health Insurance and Plans.

Hands-on Training in a Virtual World: Novel Simulation-based Virtual Training for Subdermal Contraceptive Implant Placement and Removal

The COVID-19 pandemic necessitated a shift from traditional face-to-face instruction for new technical skills to virtual delivery of medical education training. Our objectives were to develop and validate a virtual simulation training program for Canadian healthcare professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant.

Subdermal Contraceptive Implants and Repeated Teenage Motherhood: Evidence from a Major Maternity Hospital-Based Programme in Uruguay

Subdermal Contraceptive Implants and Repeated Teenage Motherhood: Evidence from a Major Maternity Hospital-Based Programme in Uruguay

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

PurposeTo investigate the association between intrauterine device (IUD) use and hip pain, orthopaedic visits for hip pain, and arthroscopic hip surgery.MethodsThis was a retrospective cohort study of patients aged 18-44 years old using either IUDs or subdermal implants for contraception in a large commercial claims database (MarketScan) from 2012 to 2015. All patients had at least 12 months of continuous enrollment both before and after contraceptive placement. Patients with a history of hip pain or surgery were excluded. The primary outcome was new hip pain. Secondary outcomes included visiting an orthopaedic or sports medicine provider for a hip complaint, intra-articular hip injection, and arthroscopic hip surgery. Outcomes were analyzed with Cox proportional-hazard models.ResultsWe identified a total of 242,383 patients, including 216,541 (89.3%) with IUDs and 25,842 (10.7%) with subdermal contraceptive implants. In time-to-event analysis, IUDs (vs implants) were not associated with increased risk of new hip pain diagnoses (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.87-1.03, P = .21). In contrast, both age (P < .001) and region (P < .001) were associated with increased risk of new hip pain. Similar results were seen for the secondary outcomes, including risk of orthopaedic visits for hip complaints (HR 1.06, 95% CI 0.83-1.35, P = .63), intra-articular injections of the hip (HR 0.94, 95% CI 0.63-1.41, P = .77), and hip arthroscopy procedures (HR 1.13, 95% CI 0.53-2.40, P = .75).ConclusionsIn this study, we found no evidence that IUDs were associated with hip pain or surgery.Level of EvidenceLevel III, retrospective cohort.

Birth Collapse and a Large-Scale Access Intervention with Subdermal Contraceptive Implants.

Between 2016 and 2018, we observe in Uruguay a steep decline of almost 20 percent in the number of total births, leading to the collapse of the adolescent fertility rate after decades of relative stagnation. We estimate the quantitative contribution on birth rates, especially teen births, of a policy of expanded availability of subdermal contraceptive implants. We exploit the expansion schedule of a large-scale policy of free-of-charge access to subdermal implants in the country's public health system through an event study to capture causal effects. We use detailed birth administrative records for the past 20 years. We document an average reduction of 3 percent in the birth rate in public health facilities across the two years after the policy was implemented in each department. These reductions were notably higher among teens and first births. Although changes in women's fertility decisions are a multicausal phenomenon, we claim that the expanded availability of subdermal contraceptive implants accounted for one-third of the teen and young women's birth collapse.

Subdermal Contraceptive Implant Insertion Trends and Retention in Adolescents.

There is growing advocacy for use of long-acting reversible contraception among sexually active adolescents. Our primary aims were to evaluate the etonogestrel subdermal contraceptive implant (SCI) insertion trends among adolescents, as well as SCI retention at 1, 2, and 3years, indications for removal, and to identify pregnancies that occurred during SCI use. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A retrospective cohort study was conducted of adolescents aged 13-19years with SCI insertions in 2008-2014 within a large integrated health care system. Demographic and clinical characteristics included age, race/ethnicity, body mass index, gravidity, parity, insertions, reinsertions, indications for removal, and pregnancy. Electronic medical record review was conducted on a randomized sample of 540 adolescents with insertions during 2008-2011 for the retention objective to validate electronically extracted variables. Analyses included descriptive statistics, survival analysis with Kaplan-Meier estimates for implant retention and Cochran-Armitage trend test for insertions according to year during 2008-2014. Most adolescent SCI users were non-Hispanic white (43%), or Hispanic (34.2%) and 16years or older (84.2%) at the time of insertion. Overall, 1-, 2-, and 3-year retention rates were 78.6%, 59.4%, and 26.2%, respectively, with retention at 44.3% at 2years 9months (indicative of removal of method for near expiration of 3-year device). The insertion rate trend showed statistically significant increases annually, from 0.14% in 2008 to 0.91% in 2014; P<.0001. No pregnancies were documented during implant use. The most common indication for SCI removal was device expiration. SCI insertions increased annually among adolescents, with more than a sixfold increase over the 6-year study period, and more than half of the SCIs were retained through 2years of use. The most common indication of SCI removal was completion of Food and Drug Administration-approved duration.

Evaluation of subdermal implants among family planning acceptors in a tertiary hospital, Nigeria

Background: Subdermal contraceptive implants are safe, convenient, very effective and reversible. Though they have numerous benefits, their use is still discontinued due to various reasons including side effects in the body of acceptors. Objective: To determine and compare the prevalence rates, side effects, discontinuation rates and indications for discontinuation of two subdermal implants (Jadelle and Implanon) at Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria. Methods: A retrospective study of 874 clients attending family planning clinic at the RSUTH from 1st January, 2015 – 31st December, 2019 was conducted. Their records were retrieved from the clinic and reviewed. Data was extracted, coded and analyzed using the statistical package for social sciences (SPSS) IBM version 25.0 (Armonk, NY). Result: Four hundred and twenty five women used subdermal implants out of 874 acceptors of contraceptives within the study period giving an uptake rate of 48.6%. Implanon was more preferred accounting for 66.6% and Jadelle 33.4%. The mean age was 33.24+4.13 years. Most age group was 30-34 years accounting for 51.3%. Age range was 20-48 years and most (80%) were multiparous. Most (99.1%) were Christians and 98.4% were married. Only one client (0.2%) had no formal education. Seventy three (26.4%) acceptors discontinued the use. Most were due to desire for pregnancy (46.4%) and menorrhagia (24.1%). Four unintended pregnancies occurred giving a Pearl index of 0.9. Conclusion: Subdermal implants are safe and effective. Menstrual abnormality and desire for pregnancy were the commonest reasons for discontinuation.

Location and removal of non-palpable subdermal single-rod contraceptive implant.

The objective of the study was to present the experience of the family planning service Hospital General de México, in locating and removing no palpable subdermal single-rod contraceptive implants. A descriptive, prospective, and cross-sectional study was performed from January 2011 to April 2018. Hundred and sixty-four patients in whom the implant was not palpable were reviewed, the time between insertion and removal averaged 3.3 years (maximum 10 years and minimum 3 months). Three implants were inserted in the right arm, the rest on the left one. Forty-seven implants were found in fatty tissue (29%), 18 in fascia (11%), 94 in muscle (57%), 2 in the armpit (1.2%), and 3 were not found (1.8%). The no palpable implant is caused by an incorrect insertion technique. Migration should not be assumed as a cause of difficult location. Amount of non-palpable implants is not possible to determine due to a lack of records, but approximately 3% are considered non-palpable. Ultrasound has proven to be the study of choice to locate an incorrect inserted implant. In this case, the total number of implants was located, except in two patients.

ADVERSE EFFECTS OF SUBDERMAL CONTRACEPTIVE IMPLANTS IN USERS OF THE HOSPITAL: DRA. MATILDE HIDALGO DE PRÓCEL

The present study has as a priority to determine the adverse effects of subdermal contraceptive implants in the users of the Maternal and Child Hospital “Dra. Matilde Hidalgo de Prócel” from May to October 2017, a study was carried out using quantitative methodology, applying an analytical and synthetic method, through surveys applied to 98 users attended at the Matilde Hidalgo de Prócel Hospital. We found that the age group with the greatest use of implants is between 20 and 35 years old, representing 83% of the population. We determined that in the users who use the subdermal implant as a contraceptive method they have an adverse effect related to the emotional lability represented in 51%, referring to the alterations of the menstrual flow, we registered that 46% of the users who used the implant, presented an alteration of your menstrual cycle characterized by a lack of menstruation for more than 3 months. Headache was presented as the main biological effect with 31%, followed by 29% with weight gain, in terms of implant effectiveness, 43% of the users surveyed said they accessed it for its effectiveness. We found that Implanon (3 years) is the type of implant most used by the users represented by 70% of the sample.

The Impact of Body Mass Index on Bleeding Pattern in Women Discontinuing Usage of a Subdermal Contraceptive Implant [34I

INTRODUCTION: The etonogestrel subdermal contraceptive implant is among the most effective contraceptive methods available. The most common associated side effect is irregular menstrual bleeding. Approximately 15% of users discontinue implant usage prematurely due to unacceptable bleeding. Understanding of how obesity impacts the side effect profile of the implant is limited, since the initial clinical trials excluded obese patients. However, recent studies have suggested that obese patients are less likely report irregular or heavy bleeding than are their normal-weight counterparts, although these studies were small and examined predominately white patients. We sought to study whether BMI impacted the bleeding pattern of implant users in our large, racially diverse population. METHODS: This study was deemed exempt from the UT Austin IRB. We conducted a chart review of patients in Austin’s CommUnity Care clinic system who had an implant removed between 2012 and 2017. For each subject, we abstracted age, race/ethnicity, gravidity/parity, BMI, and indication for implant discontinuation. Univariate analysis was conducted to determine whether the reason for implant discontinuation varied between underweight, normal-weight, overweight, and obese patients. RESULTS: Data were abstracted for 636 subjects. 40% of normal-weight subjects discontinued usage of a contraceptive implant due to irregular bleeding, compared to 55% of underweight and 26% of obese subjects. Duration of implant usage did not vary between BMI classes. CONCLUSION: Underweight women were more likely to discontinue implant usage due to irregular bleeding than normal-weight women, and obese women were less likely to do so. This may guide counseling regarding expected bleeding pattern for prospective implant users.