Reproductive Health Global Program

Sayana Press home and self-injection

Self-injection resources

Sayana Press self-injection training materials (2016)
Self-injection training materials for health care providers and clients are now available as part of PATH’s Sayana Press training curriculum. These include in-depth PowerPoint slides to orient providers on training and supporting their clients for successful self-injection. Also included is a client instruction booklet which serves as both a training and memory aid for use when clients self-inject. Designed for low-literate users, the instruction booklet is highly visual. For further information, please email sayanapress@path.org.

Sayana Press: A Guide for Trainers of Providers
See “Lesson 9: How to counsel clients on Sayana Press self-injection”

Lesson 9 slides: How to counsel clients on Sayana Press self-injection

Sayana Press self-injection instruction booklet for clients

Sayana Press self-injection job aid for clients

Checklist for Sayana Press Self-Injection Practice

Practice Calendar: 2017–2018

Designing a contraceptive self-injection program: Experience from Uganda (2017)
In late 2016, self-injection of subcutaneous DMPA (Sayana Press) was rolled out in public facilities in one district of Uganda. Building on research findings and self-injection introduction experiences, PATH launched the Self-injection Best Practices project in early 2017, applying user-centered design principles to understand how self-injection delivery will work in diverse contexts and delivery channels. During this June 1, 2017 webinar, presenters described the program design process and shared insights and lessons learned so far.

The promise of contraceptive self-injection: Evidence from Uganda (2017)
Self-injection of contraception holds great promise for helping women and adolescent girls overcome access barriers and empowering them to manage their health. Building on previous self-injection research conducted in the US and Europe, a PATH/Ministry of Health study in Uganda found that self-injection is both feasible and highly acceptable among most study participants in Uganda. During this webinar held on January 19, 2017, presenters provided background on contraceptive self-injection and shared the study results from Uganda, as well as program implications.

Stakeholder Views on Self-Injection of DMPA-SC in Senegal and Uganda (2016)
In 2014, PATH conducted interviews with stakeholders in Senegal and Uganda to assess receptivity to self-injection of subcutaneous contraceptive Sayana Press as well as the evidence requirements and processes necessary to chart a course for adoption, introduction, and scale-up of self-injection as a service-delivery practice in the two countries.

Self-administration of injectable contraception (2015)
The World Health Organization guidance document, “Health worker roles in providing safe abortion care and post-abortion contraception” includes a section outlining recommendations for the self-administration of injectable contraceptives by women (see page 62). Contraceptive self-injection is recommended “in contexts where mechanisms to provide the woman with appropriate information and training exist, referral linkages to a healthcare provider are strong, and where monitoring and followup can be ensured.”

Pfizer’s Sayana® Press Becomes First Injectable Contraceptive In The United Kingdom Available For Administration By Self-Injection (2015)
In 2015, the United Kingdom’s lead regulatory agency, the Medicines & Healthcare products Regulatory Agency (MHRA), authorized self-injection of Sayana Press in that country. This update to the Sayana Press label adds the option for self-injection when considered appropriate by a health care professional, making it the first injectable contraceptive in the United Kingdom available for self-administration.

Feasibility of Home and Self-Injection of Sayana Press in Ethiopia: Results of a Qualitative Study (2013)
This 2012 qualitative study investigated the perceptions and policy implications of home and self-injection of Sayana Press in Ethiopia’s Oromia region. Sayana Press is the subcutaneous formulation of the three-month injectable depot medroxyprogesterone acetate (DMPA) in the Uniject™ injection system. This study did not include actual product use in humans.

Home-Based Administration of depo-subQ provera 104™ in the Uniject™ Injection System (2011)
This literature review details the key findings on the feasibility and acceptability of home delivery of depo-subQ in Uniject (now known as Sayana Press). The review focused on self-injection and looked specifically at subcutaneous DMPA compared to the intramuscular formulation; considerations for home administration of injectable contraception, particularly in low-resource settings; and identified research needs for home administration, including self-injection, of depo-subQ in Uniject. A six-page briefing summary of this review is also available.

PATH Subcutaneous DMPA Update newsletter
This newsletter provides information and updates on subcutaneous DMPA/Sayana Press self-injection research conducted by PATH as well as other self-injection news.

Peer-reviewed literature on self-injection

Evaluating the feasibility and acceptability of self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA) in Senegal: a prospective cohort study (2017)
Cover J, Ba M, Lim J, Drake JK, Daff BM. Contraception.

This study aimed to measure the proportion of participants who self-injected subcutaneous depot medroxyprogesterone acetate self-injection competently three months after training, measure the proportion who self-injected on time, and assess acceptability of self-injection. In the study, 378 women aged 18 to 49 years were trained to self-inject by study nurses. Three months later, women returned unprompted to the clinic to self-inject, and technique and visit timing were evaluated. Women continuing with a third self-injection were followed up at home after their next scheduled injection date. Among the 337 participants followed up three months posttraining, 310 self-injected and 87 percent did so competently. The vast majority of participants (93 percent) expressed a desire to continue. These first research results on contraceptive self-injection in West Africa indicate feasibility and acceptability of the practice. Results underscore the importance of designing self-injection programs that empower and support women, including those with limited education.

A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection (2016)
Cover J, Namagembe A, Tumusiime J, Lim J, Drake JK, Mbonye AK. Contraception. 2016.
Evidence on contraceptive self-injection from the United States and similar settings is promising, and the practice may increase access. The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability. Of 368 participants followed up 3 months posttraining, 88% demonstrated injection competence and 95% reinjected on time, while 87% were both on time and competent. Nearly all (98%) expressed a desire to continue.

Home-based administration of Sayana® Press: review and assessment of needs in low-resource settings (2014)
Keith B, Wood S, Tifft S, Hutchings J. Contraception. 2014;89(5)344–351.
Studies indicate that lay caregiver and self-injection of various medications, including other injectable presentations of subcutaneous DMPA, are acceptable and effective. Introduction of Sayana Press in developing countries could extend injectable contraceptive delivery safely and effectively beyond the clinic and, eventually, into the home, allowing lay caregiver or self-administration. Research needs for low-resource settings include assessing the acceptability and feasibility of self-injection with Sayana Press. Feasibility studies necessary for implementing a sustainable home-based delivery program include assessment of training, health systems, policies, infrastructure needs and programmatic considerations to optimize women’s ability to manage their self-injection schedule.

Perceptions of home and self-injection of Sayana® Press in Ethiopia: a qualitative study (2014)
Keith B, Wood S, Chapman C, Alemu E. Contraception. 2014;89(5)379–384.
Sayana Press has the potential to expand non-clinic access to contraception, including home and self-injection (HSI). This study collected information from potential users and stakeholders on their perceptions and preferences, the feasibility of a Sayana Press home and self-injection program and key policy considerations.

Randomized clinical trial of self versus clinical administration of subcutaneous depot medroxyprogesterone acetate (2014)
Beasley A, White KO, Cremers S, Westhoff C. Contraception. 2014;89(5):352–356.
This study aimed to evaluate feasibility, acceptability, continuation, and trough serum levels following self-administration of subcutaneous (sc) depot medroxyprogesterone acetate (DMPA). Sixty-three percent of women approached were interested in trying self-administration of DMPA and nearly all eligible for enrollment were successful at doing so. Self-administration and clinic administration resulted in similar continuation rates and similar DMPA serum levels. The authors concluded that self-administration of sc DMPA is feasible and may be an attractive alternative for many women.

Self-administration of subcutaneous depot medroxyprogesterone acetate by adolescent women (2013)
Williams RL, Hensel DJ, Fortenberry JD. Contraception. 2013;88(2):401–407.
The intramuscular contraceptive depot medroxyprogesterone acetate (DMPA-IM) is now available in subcutaneous (SC) formulation, potentially allowing for home-based self-administration. The authors conducted the first examination of adolescent women’s interest in and proficiency at DMPA-SC self-administration.

Pilot study of home self-administration of subcutaneous depo-medroxyprogesterone acetate for contraception (2012)
Cameron ST, Glasier A, Johnstone A. Contraception. 2012;85(5):458–464.
This was a pilot study of self-administration of DMPA-SC. Existing users of the intramuscular preparation (DMPA-IM) who wished to self-inject (n=64) were taught self-administration using DMPA-SC. The authors concluded that self-administration of DMPA-SC for contraception is feasible and is associated with similar continuation rates and satisfaction to clinician-administered DMPA-IM.

Self-administration of subcutaneous depot medroxyprogesterone acetate for contraception: feasibility and acceptability (2012)
Prabhakaran S, Sweet A. Contraception. 2012;85(5):453–457.
The objectives of the study were to assess feasibility, continuation rates and patient satisfaction with self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC). Continuation was high with DMPA-SC self-injection. Participants reported injection to be easy and convenient and are likely to recommend self-administration to other women. Device issues are one potential deterrent.

The acceptability of self-administration of subcutaneous Depo-Provera (2005)
Lakha F, Henderson C, Glasier A. Contraception. 2005;72(1):14–18.
In a questionnaire survey of 176 women currently using DMPA, 67% preferred to self-administer. Of the 33% who did not wish to self-administer, the most common reasons were a fear of needles and concern regarding incorrect administration. In a second survey of 313 women not currently using DMPA, 64% of women said they would prefer to attend less often for contraceptive supplies. Twenty-six percent of women who had never used DMPA and 40% of ex-users would seriously consider DMPA if self-administration were possible. The authors conclude that the findings suggest that the advent of subcutaneous self-administrable Depo-Provera with appropriate training and reminder system is likely to be beneficial and popular with many women.

Self-administration with Uniject® of the once-a-month injectable contraceptive Cyclofem® (1997)
Bahamondes L, Marchi NM, Nakagava HM, et al. Contraception. 1997;56:301–304.
The objective of this study was to evaluate women’s acceptance of and ability to self-administrate the injectable contraceptive Cyclofem® using prefilled Uniject devices. Findings indicated that women can be trained to successfully self-administer the monthly injectable contraceptive Cyclofem and generally respond positively to Uniject.