Expanding Services for Injectables

CONTENTS

Home (Key Points)

Injectables Today and Tomorrow
Box: Injectables Tomorrow: Subcutaneous DMPA and Home Injection
Web Table 1. Knowledge and Current Use of Injectable Contraceptives Reported by Married Women 15–49, All Surveys 1990–2006
Web Table 2. Knowledge and Current Use of Injectable Contraceptives Reported by Married Women 15–49, Most Recent Surveys 1990–2006
Web Figure. Donor Shipments of Injectables Increasing

Supply Meets Demand With Forecasting and Ingenuity
Web Table 3. Key Resources for Program Managers and Providers

Training to Meet Demand

Box: With Training, a Range of Providers Can Give Contraceptive Injections

Give Injections and Dispose of Waste Safely

Community Programs Can Safely Increase Access to Injectables

Meeting Rising Demand Efficiently

Communication Helps Women Try and Use Injectables

Questions and Answers About Injectables

Box: Women With HIV/AIDS Can Use Injectables

Bibliography

Credits

Coming Soon: "Injectables Toolkit" Web site. Go to http://www.injectablestoolkit.org for job aids and information about injectable contraceptives.

• Table 1: Estimated Worldwide Use of Injectables Among Married Women Ages 15–49, 2006
• Table 2: Formulations, Injection Schedules, and Availability of Injectable Contraceptives
• Table 3: Key Resources for Program Managers and Providers

Tools for Program Managers
• Checklist: Good-Quality Injectables Services
• Checklist: Improving Access to Injectables

Tools for Providers are in the companion INFO Reports. See also Population Reports, "When Contraceptives Change Monthly Bleeding," Series J, No. 54, August 2006.

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See Companion INFO Reports on "Injectable Contraceptives: Tools for Providers"
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Women With HIV/AIDS Can Use Injectables

Injectables are safe and effective for women who have HIV, including those who have AIDS and those who are taking antiretroviral (ARV) medications. Effective contraception helps women avoid the health risks of unintended pregnancy with HIV infection, including mother-to-child transmission of HIV (119, 148). Also, although there have been few studies, there is evidence that some ARV medications harm a fetus. Women should use efavirenz, for example, only if they use effective contraception (214).

There have been theoretical concerns that ARV medications could reduce the effectiveness of hormonal contraceptives because some medications speed up liver metabolism (141). One small study of women using efavirenz, nelfinavir, or nevirapine reported that after an injection of DMPA, levels of progesterone indicated that no women ovulated (33). A study of an oral contraceptive, however, reported that nevirapine had a significant effect on both estrogen and progestin levels (114). Even if an ARV medication did decrease the hormone level in the blood somewhat, users are probably still well protected against pregnancy because DMPA is nearly as effective for three months at a 100 mg dose as at the usual 150 mg dose (203). To date, no studies have looked at NET-EN or combined injectable contraceptives.

Because of the concerns about decreased effectiveness, it has been suggested that women using nevirapine and DMPA be especially urged to return on time for injections (173). Women using nevirapine or other ARV medications who return late but within two weeks of their injection date, however, should not be denied an injection. No evidence supports shortening the interval between injections for women using ARV medications.

The few studies available find that DMPA has little or no effect on the plasma concentration of ARV medications (33) or on their effectiveness as measured by the plasma concentration of lymphocytes (white blood cells) and HIV (32).

Injectable contraceptives offer no protection against transmission of HIV or other sexually transmitted infections. Used consistently and correctly, male or female condoms help prevent transmission of infection. Condoms can be used along with injectables and with other family planning methods. Also, monogamy or at least reducing the number of sexual partners can lower the risk of HIV infection.