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Curtis KM, Nguyen AT, Tepper NK, Zapata LB, Snyder EM, Hatfield-Timajchy K, Kortsmit K, Cohen MA, Whiteman MK. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73:1-77. [PMID: 39106301 PMCID: PMC11340200 DOI: 10.15585/mmwr.rr7303a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
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Affiliation(s)
- Kathryn M. Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Antoinette T. Nguyen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Lauren B. Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Emily M. Snyder
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Megan A. Cohen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Maura K. Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Hoppes E, Rademacher KH, Wilson L, Mahajan TD, Wilson K, Sommer M, Solomon M, Lathrop E. Strengthening Integrated Approaches for Family Planning and Menstrual Health. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300080. [PMID: 37903573 PMCID: PMC10615238 DOI: 10.9745/ghsp-d-23-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/29/2023] [Indexed: 11/01/2023]
Abstract
FP and menstrual health integration has the potential to improve individuals' health and well-being. The authors describe potential ways to integrate FP and menstrual health, outlining steps that stakeholders can take in designing integrated approaches.
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Affiliation(s)
| | | | | | | | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, NY, USA
| | | | - Eva Lathrop
- Population Services International, Washington, DC, USA
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Dallaire J, Hazell M, Kottke MJ. Implementation of Pregnancy Checklist into Clinic Workflow: A Quality Improvement Initiative. J Pediatr Adolesc Gynecol 2020; 33:536-542. [PMID: 32535215 DOI: 10.1016/j.jpag.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 05/30/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This project aims to implement the Pregnancy Reasonably Excluded Guide in an outpatient family planning teen clinic using the EPIDEM quality improvement (QI) framework. DESIGN Quality improvement. SETTING Outpatient family planning teen clinic in an urban center. PARTICIPANTS Female teen clinic patients (13-19 years of age). INTERVENTIONS We used the EPIDEM (Explore relevant issues and contextual factors, Promote to the right people, Implement timely solutions, Document steps, Evaluate with meaningful measures, Make modifications to improve interventions further) QI framework to implement the Pregnancy Reasonably Excluded Guide in our clinic. MAIN OUTCOME MEASURES The primary outcome was the percentage of eligible visits in which the checklist was used. The secondary outcome was the percentage of encounters in which a UPT was ordered pre- and post-implementation. RESULTS A total of 383 eligible encounters were reviewed pre- and post-implementation. Before implementation, there was no use of the checklist in clinic. After implementation, 81.8% of eligible encounters used the checklist. Before implementation, 37.3 % of encounters had a UPT ordered. After implementation, 27.0% of encounters had a UPT ordered; there was a 27.6% decrease in UPTs ordered (P = .036). CONCLUSION The pregnancy checklist can be successfully implemented using QI methodology, and the EPIDEM QI framework is a valuable clinical tool for the implementation of a context-sensitive protocol. Use of the pregnancy checklist is standard of care and has the capacity to reduce the number of unnecessary UPTs, which may provide time and cost savings in a broad range of clinical settings.
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Affiliation(s)
| | - Mallory Hazell
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Melissa J Kottke
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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O’Laughlin DJ, Casey PM, Jensen CE, Long ME. Pregnancy Reasonably Excluded Guide (PREG) Evaluation of Pregnancy Status Before Contraceptive Procedures: Improved Availability of Same-Day Insertion. Mayo Clin Proc Innov Qual Outcomes 2020; 4:295-304. [PMID: 32542221 PMCID: PMC7283570 DOI: 10.1016/j.mayocpiqo.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/03/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine whether implementation of the Pregnancy Reasonably Excluded Guide (PREG) in a primary care gynecology clinic improves access to contraceptive procedures and affects the number of urine human chorionic gonadotropin (hCG) tests. PATIENTS AND METHODS PREG was administered to 981 women aged 18 to 50 years (1012 visits) who were seen in a primary care gynecology clinic for contraceptive procedures from September 30, 2015, through April 30, 2018. Contraceptive procedures included insertion of an intrauterine contraceptive (IUC) or subdermal contraceptive implant. After PREG review and patient discussion, health care professional decided to perform the procedure with or without hCG measurement or to reschedule if the patient's pregnancy status was uncertain. We collected data on the rate of same-day contraceptive procedures and the rate of hCG testing. Data from the PREG implementation period were compared with historical data from 185 women undergoing contraceptive procedures before PREG implementation. RESULTS Measurement of hCG was performed in 53% of women before and 24.1% (224 of 1,012 visits) after PREG implementation in the primary care setting. After PREG implementation, 974 0f 1012 patients (96.2%) were eligible for a same-day contraceptive procedure. If traditional criteria, current menses, or a preexisting IUC or implant in place were required for IUC or implant insertion, only 594 patients (58.7%) would have qualified for a same-day procedure. No contraceptive procedures occurred in pregnant women. CONCLUSION PREG implementation allowed for same-day IUC or implant insertion in 974 women (96.2%) seen for a contraceptive procedure. Most of the women (75.9%) did not require preprocedure hCG measurement.
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Affiliation(s)
| | - Petra M. Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Claire E. Jensen
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Margaret E. Long
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
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Implementation of the “Pregnancy Reasonably Excluded Guide” for Pregnancy Assessment. Obstet Gynecol 2018; 132:1222-1228. [DOI: 10.1097/aog.0000000000002917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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DeBoer TH, Hensley JG. Increasing Accessibility to Long-Acting Reversible Contraception in a Public Health Setting. Nurs Womens Health 2018; 22:302-309. [PMID: 30077236 DOI: 10.1016/j.nwh.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/23/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To increase access to long-acting reversible contraception (LARC) by developing and implementing evidence-based criteria for LARC insertions at a public health clinic. DESIGN A quality improvement pilot project aimed at improving access to LARC for women of reproductive age and decrease associated costs. SETTING/LOCAL PROBLEM Eligibility criteria for LARC at a public health clinic in rural Georgia required two clinic visits and unnecessary screening tests for women interested in these methods. These criteria limited eligibility of candidates who desired LARC, increased time between requests for and insertion of LARC, and increased costs. PARTICIPANTS Fifteen women of reproductive age who were uninsured or underinsured had a LARC inserted during project implementation. INTERVENTION/MEASUREMENTS The average number of days between visits based on the old (2007) criteria was compared with the average number of days between visits after implementation of the new (2017) criteria, with specific focus on the number of same-day LARC insertions. A secondary analysis of cost savings was calculated. RESULTS After implementation of the 2017 criteria, a statistically significant (p < .01) decrease in the mean number of days between request for and insertion of LARC was noted. Every woman who requested a LARC received it, and more than half of LARC insertions were provided the same day. Furthermore, the clinic noted savings of nearly $1,000 on LARC insertions. CONCLUSION The wait time for LARC insertion substantially decreased, and more than half of women had a LARC inserted the same day they requested it. By decreasing the wait time between request for and insertion of a LARC and implementing a policy to advocate for same-day insertion, use of the 2017 criteria decreased women's risk for unintended pregnancy.
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Kharod SM, Greenwalt J, Dessaigne C, Yeung A. Pregnancy testing in patients undergoing radiation therapy. Ecancermedicalscience 2017; 11:753. [PMID: 28798811 PMCID: PMC5533601 DOI: 10.3332/ecancer.2017.753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Indexed: 11/25/2022] Open
Abstract
Radiation therapy (RT) can be lethal to a developing fetus; therefore, determining pregnancy status before RT is essential. We here sought to determine how many women treated with RT at our institution for over one year were at risk for pregnancy when starting RT. We retrospectively reviewed the medical records of all female patients 12–55 years old treated with radiation, i.e. 1 October 2012 to 31 September 2013. Patients were categorised as ‘at risk’ if they had a uterus and ‘no risk’ if they had a hysterectomy. Documented birth control, pregnancy test status, and timing of the pregnancy test in relation to the radiation start date were recorded. We included 131 female patients with a median age of 48 years (range 14–55 years). Breast cancer was the most prevalent disease site (18%) followed by head/neck and central nervous system (both 11%). Of the 131 patients, 35 were deemed ‘no risk’ and 95 (72%) were ‘at risk’. Pregnancy testing of the ‘at risk’ population was done in 47%, but only 17% of the pregnancy testing was performed accurately, which we defined as a test performed within 14 days before starting RT. Over one year, 66% (63/95) of ‘at risk’ women were not tested appropriately before starting RT. Most (66%) women of child-bearing age with an intact uterus receiving RT at our institution were not appropriately tested for pregnancy before the initiation of RT. These data laid the foundation for our formal pregnancy testing policies for women undergoing RT.
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Affiliation(s)
- Shivam M Kharod
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Julie Greenwalt
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Camille Dessaigne
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Anamaria Yeung
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
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Kottke M, Hailstorks T. Improvements in Contraception for Adolescents. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kolesar RJ, Audibert M, Comfort AB. Cost-effectiveness analysis and mortality impact estimation of scaling-up pregnancy test kits in Madagascar, Ethiopia and Malawi. Health Policy Plan 2017; 32:869-881. [PMID: 28387867 DOI: 10.1093/heapol/czx013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Abstract
Cost-effective, innovative approaches are needed to accelerate progress towards ending preventable infant, child and maternal mortality. To inform policy decisions, we conducted a cost-effectiveness analysis of adding urine pregnancy test kits to the maternal and reproductive services package offered at the community level in Madagascar, Ethiopia and Malawi. We used a decision tree model to compare the intervention with the status quo for each country. We also completed single factor sensitivity analyses and Monte Carlo simulations with 10 000 iterations to generate the probability distribution of the estimates and uncertainty limits. Among a hypothetical cohort of 100 000 women of reproductive age, we estimate that over a 1-year period, the intervention would save 26, 35 and 48 lives in Madagascar, Ethiopia, and Malawi, respectively. The Incremental Cost Effectiveness Ratio (ICER) for the cost per life saved varies by country: $2311 [95% Uncertainty Interval (UI): $1699; $3454] in Madagascar; $2969 [UI: $2260; $5041] in Ethiopia and $1228 [UI: $918; $1777] in Malawi. This equates to an average cost per Disability Adjusted Life Year (DALY) averted of $36.28, $47.95 and $21.92, respectively. Based on WHO criteria and a comparison with other maternal, newborn, and child health interventions, we conclude that the addition of urine pregnancy tests to an existing community health worker maternal and reproductive services package is highly cost-effective in all three countries. To optimize uptake of family planning and antenatal care services and, in turn, accelerate the reduction of mortality and DALYs, decision makers and program planners should consider adding urine pregnancy tests to the community-level package of services.
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Affiliation(s)
- Robert J Kolesar
- Université Clermont Auvergne, CNRS, CERDI, F-63000 Clermont-Ferrand, France
| | - Martine Audibert
- Université Clermont Auvergne, CNRS, CERDI, F-63000 Clermont-Ferrand, France
| | - Alison B Comfort
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Bixby Center for Global Reproductive Health, 3333 California Street, San Francisco, CA 94143, USA
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Tepper NK, Curtis KM, Jatlaoui TC, Whiteman MK. Removing barriers to contraception through use of criteria to assess pregnancy risk. Contraception 2017; 95:323-325. [PMID: 28214517 PMCID: PMC11000531 DOI: 10.1016/j.contraception.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Naomi K Tepper
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA.
| | - Kathryn M Curtis
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA
| | - Tara C Jatlaoui
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA
| | - Maura K Whiteman
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA 30341, USA
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Morroni C, Findley M, Westhoff C. Does using the "pregnancy checklist" delay safe initiation of contraception? Contraception 2017; 95:331-334. [PMID: 28131649 DOI: 10.1016/j.contraception.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Chelsea Morroni
- University College London Institute for Women's Health and Institute for Global Health; The Botswana UPenn Partnership; University of the Witwatersrand, Wits Reproductive Health and HIV Institute.
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Stanback J, Yacobson I, Harber L. Proposed clinical guidance for excluding pregnancy prior to contraceptive initiation. Contraception 2016; 95:326-330. [PMID: 27888046 DOI: 10.1016/j.contraception.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/09/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Rattray C, Wiener J, Legardy-Williams J, Costenbader E, Pazol K, Medley-Singh N, Snead MC, Steiner MJ, Jamieson DJ, Warner L, Gallo MF, Hylton-Kong T, Kourtis AP. Effects of initiating a contraceptive implant on subsequent condom use: A randomized controlled trial. Contraception 2015; 92:560-6. [PMID: 26079469 PMCID: PMC11268953 DOI: 10.1016/j.contraception.2015.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate whether initiation of a contraceptive implant, a method of long-acting reversible contraception, reduces condom use, as measured by a biomarker of recent semen exposure [prostate-specific antigen (PSA)]. STUDY DESIGN We conducted a randomized controlled clinical trial in which 414 Jamaican women at high risk for sexually transmitted infections (STIs) attending family planning clinics received the contraceptive implant at baseline ("immediate" insertion arm, N=208) or at the end ("delayed" insertion arm, N=206) of a 3-month study period. Participants were tested for PSA at baseline and two follow-up study visits and were asked about their sexual activity and condom use. RESULTS At baseline, 24.9% of women tested positive for PSA. At both follow-up visits, the prevalence of PSA detection did not significantly differ between the immediate versus delayed insertion arm [1-month: 26.1% vs. 20.2%, prevalence ratio (PR)=1.3, 95% confidence interval (CI)=0.9-1.9; 3-month: 25.6% vs. 23.1%, PR= 1.1, 95% CI=0.8-1.6]. The change in PSA positivity over the three study visits was not significantly larger in the immediate arm compared to the delayed arm (1-sided p-value of .15). CONCLUSIONS Contraceptive implants can be successfully introduced into a population at high risk of unintended pregnancy and STIs without a biologically detectable difference in unprotected sex in the short term. This information strengthens the evidence to support promotion of implants in such populations and can help refine counseling for promoting and maintaining use of condoms among women who choose to use implants. IMPLICATIONS Sex unprotected by a condom was not higher over 3 months in women receiving a contraceptive implant, compared with those not receiving the implant.
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Affiliation(s)
- Carole Rattray
- University Hospital of the West Indies, Kingston, Jamaica
| | - Jeffrey Wiener
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Karen Pazol
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Markus J Steiner
- Family Health International (FHI 360), Research Triangle Park, NC, USA
| | | | - Lee Warner
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria F Gallo
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Tina Hylton-Kong
- Epidemiology Research and Training Unit, Ministry of Health, Kingston, Jamaica
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Comfort AB, Chankova S, Juras R, Hsi CN, Peterson LA, Hathi P. Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar. Contraception 2015; 93:44-51. [PMID: 26409247 DOI: 10.1016/j.contraception.2015.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To improve access to contraceptives in remote and rural areas, sub-Saharan African countries are allowing community health workers (CHWs) to distribute hormonal contraceptives. Before offering hormonal contraceptives, CHWs must determine pregnancy status but often lack a reliable way to do so. No studies have evaluated the impact of providing CHWs with urine pregnancy test kits. We assessed the impact of giving CHWs free pregnancy test kits on the number of new clients purchasing hormonal contraceptives from CHWs. STUDY DESIGN We implemented a randomized experiment in Eastern Madagascar among CHWs who sell injectable and oral hormonal contraceptives. A total of 622 CHWs were stratified by region and randomly assigned at the individual level. Treatment-group CHWs were given free pregnancy tests to distribute (n analyzed=272) and control-group CHWs did not receive the tests (n analyzed=263). We estimated an ordinary least-squares regression model, with the monthly number of new hormonal contraceptive clients per CHW as our primary outcome. RESULTS We find that providing CHWs with free pregnancy test kits increases the number of new hormonal contraceptive clients. Treatment-group CHWs provide hormonal contraceptives to 3.1 new clients per month, compared to 2.5 in the control group. This difference of 0.7 clients per month (95% confidence interval 0.13-1.18; p=.014) represents a 26% increase. CONCLUSIONS Giving CHWs free pregnancy tests is an effective way to increase distribution of hormonal contraceptives. As pregnancy tests become increasingly affordable for health-care systems in developing countries, community-based distribution programs should consider including the tests as a low-cost addition to CHWs' services. IMPLICATIONS No study has evaluated the impact of giving CHWs free urine pregnancy test kits for distribution to improve provision of hormonal contraceptives. Giving CHWs free pregnancy test kits significantly increases the number of clients to whom they sell hormonal contraceptives. Community-based distribution programs should consider including these tests among CHWs' services.
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Affiliation(s)
- Alison B Comfort
- Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, United States.
| | - Slavea Chankova
- Abt Associates, 4550 Montgomery Avenue, Bethesda, MD 20814, United States.
| | - Randall Juras
- Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, United States.
| | - C Natasha Hsi
- Abt Associates, 4550 Montgomery Avenue, Bethesda, MD 20814, United States.
| | - Lauren A Peterson
- Abt Associates, 4550 Montgomery Avenue, Bethesda, MD 20814, United States.
| | - Payal Hathi
- Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, United States.
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Min J, Buckel C, Secura GM, Peipert JF, Madden T. Performance of a checklist to exclude pregnancy at the time of contraceptive initiation among women with a negative urine pregnancy test. Contraception 2014; 91:80-4. [PMID: 25218500 DOI: 10.1016/j.contraception.2014.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/30/2014] [Accepted: 08/03/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to measure the sensitivity and specificity of a six-item "pregnancy checklist" at excluding early- or luteal-phase pregnancy among women with a negative urine pregnancy test who were initiating contraception. STUDY DESIGN This was a secondary analysis of the Contraceptive CHOICE Project, a prospective cohort study of 9256 women in the St. Louis region. Women who had a negative urine pregnancy test on the day of enrollment were included in this analysis. Women with a positive urine pregnancy test or without urine pregnancy testing were excluded. We identified all luteal-phase pregnancies that occurred among women with a negative urine pregnancy test. We calculated the sensitivity, specificity, positive predictive value and negative predictive value (NPV) and likelihood ratios of the pregnancy checklist for excluding luteal-phase pregnancies. RESULTS There were 6929 women included in this analysis; 69% of these women met at least one checklist criterion to exclude pregnancy ("negative screen"). There were 36 luteal-phase pregnancies (0.5%) subsequently diagnosed among women with a negative urine pregnancy test. The sensitivity and specificity of the checklist were 77.7% and 69.1%, respectively. The NPV of the checklist was 99.8% and the positive predictive value was 1.3%. CONCLUSION Among women with a negative urine pregnancy test, the pregnancy checklist can be used to safely exclude more than 99% of early pregnancies at the time of contraceptive initiation. IMPLICATIONS In patients with a negative urine pregnancy test, a pregnancy checklist using six criteria based on patient history has high NPV in excluding early pregnancy. This checklist can be used to facilitate same-day initiation of contraceptive methods, including long-acting reversible contraception. Although the checklist had a high false positive rate, initiation of contraception should not be delayed in women with a "positive screen." Rather women who desire an intrauterine device or implant can be "bridged" with a shorter-acting method until pregnancy can be excluded.
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Affiliation(s)
- Jaspur Min
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Christina Buckel
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Gina M Secura
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Jeffrey F Peipert
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Tessa Madden
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
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Abstract
OBJECTIVE Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women. METHODS Study participants were a convenience sample of sexually active black females aged 14-19 years seeking care in an urban family planning clinic. Each participant provided a urine sample for pregnancy testing and was then administered the checklist in two formats, audio computer-assisted self-interview and in-person interview. We estimated measures of the checklist performance compared with urine pregnancy test as the reference standard, including negative predictive value, sensitivity, specificity, and positive predictive value. RESULTS Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted self-interview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results. CONCLUSION The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population.
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