Executive Summary
Women in the West African nation of Burkina Faso now have access to a lower-dose formulation of depot medroxyprogesterone acetate (DMPA) packaged in a novel injection system that is designed to increase access to contraception at all levels of the health system.
• Named Sayana Press, the formulation is familiar to U.S. family planners as Depo-Provera SC. The drug is packaged in Becton, Dickinson and Co.’s Uniject system, a single dose, non-reusable, pre-filled injection device.
• The global initiative to support Sayana Press introduction was launched at the 2012 London Summit on Family Planning as part of a larger effort to ensure that voluntary family planning information, contraceptives, and services reach 120 million more women and girls in the world’s poorest countries by 2020.
Women in the West African nation of Burkina Faso now have access to a lower-dose formulation of depot medroxyprogesterone acetate (DMPA) packaged in a novel injection system that is designed to increase access to contraception at all levels of the health system.
Named Sayana Press, the formulation is familiar to U.S. family planners as Depo-Provera SC (Pfizer Inc., New York City). The drug is packaged in the Franklin Lakes, NJ-based Becton, Dickinson and Co.’s Uniject system, a single dose, non-reusable, pre-filled injection device.
The Uniject injection system originally was developed by PATH, a Seattle-based international health non-profit organization, with support from the U.S. Agency for International Development (USAID). It is now licensed to Becton, Dickinson and Co. The system allows the drug to be delivered via subcutaneous injection. It also eliminates the need to prepare a needle and syringe. Each device contains 104 mg of DMPA per 0.65 mL dose. Burkina Faso is the first of four African countries to introduce the contraceptive, followed shortly by Niger, which held its formal launch in July 2014. The Uganda and Senegal launches have been scheduled to take place in September and October, according to Sara Tifft, MBA, director of the Sayana Press project at PATH. At press time, all four countries were projected to have introduced the method by November, notes Tifft.
The introductions are being led by each country’s ministry of health and are supported by a consortium of public and private partners, including the United Kingdom’s Department for International Development, the United Nations Population Fund (UNFPA), the Bill & Melinda Gates Foundation, USAID, Pfizer, and PATH.
"One of my villages, Congodjan, is 24 km from the health center, and there is a river on the pathway reducing access of these women to the health center," says Issoufou Benghaly, chief of the Urban Health Center at District of Dandé, Health Region of Hauts Bassins in Bobo Dioulasso, Burkina Faso. "With the outreach approach in the Sayana Press pilot introduction, I will be able to meet their needs, because in this area, women like to use injectable contraceptive."
Alexander Farma, a member of the health district management staff at District of Karangasso Vigué in Hauts Bassins, is sure that the introduction of the new contraceptive method will boost the district’s metrics in family planning. Why? Because the outreach approach will enable the district to reach many people located in remote areas and who would like to use injectable contraception, he notes.
Sayana Press could be a "game changer" where unmet need for family planning is the greatest, in part due to its potential for in-home or self-injection, notes a recent editorial in the medical journal Contraception.1 The global initiative to support Sayana Press introduction was launched at the 2012 London Summit on Family Planning as part of a larger effort to ensure that voluntary family planning information, contraceptives, and services reach 120 million more women and girls in the world’s poorest countries by 2020.
Contraceptive shots represent a popular family planning method among women in developing countries.2 However, in some places, women must return to a clinic every three months for a new injection, which limits access in remote and other hard-to-reach areas. With Sayana Press’ unique delivery system, injections may be provided by health workers to women at home or in other convenient settings. Because the Uniject device is nonreusable, it minimizes patient-to-patient transmission of bloodborne pathogens through needle reuse.
Sayana Press is accepted by providers and patients, research findings suggest.3,4 In an open-label observational study conducted in clinics in three districts in Senegal and community-based services in two districts in Uganda, providers administered Sayana Press to clients seeking reinjection of DMPA. Almost all providers (84/86; 98%) preferred Sayana Press over DMPA, and they noted that the prefilled/all-in-one design made preparation and administration easier and faster. Providers also thought clients preferred the shorter needle in Sayana Press because it is less intimidating and less painful.3 Women who had been using DMPA said they selected Sayana Press due to fewer side effects, fast administration, less pain, and method effectiveness.4
Research also indicates that self-injection of Sayana Press is feasible and acceptable among many women.5-7 Study findings suggest that women are capable of successfully self-administering injectable contraception via the Uniject system.8
"This initiative is a major innovation in family planning service delivery," said Steve Davis, PATH president and chief executive officer in a press statement issued with the pilot introduction. "By making injectable contraceptives available at the community level, it offers more women control over the timing and spacing of their children and a better chance at a healthy life."
-
Spieler J. Sayana Press: Can it be a "game changer" for reducing unmet need for family planning? Contraception 2014; 89(5):335-338.
-
Darroch JE, Singh S. Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. Lancet 2013; 381(9879):1756-1762.
-
Burke HM, Mueller MP, Packer C, et al. Provider acceptability of Sayana Press: results from community health workers and clinic-based providers in Uganda and Senegal. Contraception 2014; 89(5):368-373.
-
Burke HM, Mueller MP, Perry B, et al. Observational study of the acceptability of Sayana Press among intramuscular DMPA users in Uganda and Senegal. Contraception 2014; 89(5):361-367.
-
PATH. Home and Self-Injection of Sayana Press in Ethiopia: Qualitative Study. Seattle: PATH; 2013.
-
Keith B, Wood S, Tifft S, et al. Home-based administration of Sayana Press: review and assessment of needs in low-resource settings. Contraception 2014; 89(5):344-351.
-
Keith BM. Home-Based Administration of Depo-SubQ Provera 104 in the Uniject Injection System: A Literature Review. Seattle: PATH; 2011.
-
Bahamondes L, Marchi NM, Nakagava HM, et al. Self-administration with the Uniject of the once-a-month injectable contraceptive Cyclofem. Contraception 1997; 56:301-304.
