Self-administration of subcutaneous depot medroxyprogesterone acetate by adolescent women

Intramuscular depot medroxyprogesterone acetate (DMPA-IM) is now available in subcutaneous (SC) formulation, potentially allowing for home-based self-administration. We examined adolescents' interest in and proficiency at DMPA-SC self-administration.

This is a planned secondary analysis of a randomized controlled trial comparing pain between DMPA-IM and DMPA-SC. In the trial, study participants (N=55) aged 14-21 years were recruited at DMPA initiation and randomized to receive DMPA-IM or DMPA-SC. Participants received the alternate formulation at 3 months, chose formulation at 6 months and could learn self-administration at 9 months. The current analysis is of the women who chose self-administration of DMPA-SC. Proficiency was rated for each step of self-administration: independently [I], with reassurance [R], with verbal instruction [V] or nurse performed [RN]. Data were analyzed using descriptive and comparative statistics.

Thirty-five percent (19/55) of participants learned self-administration. Proficiency ratings were as follows: chose injection site (I=78.9%, R=5.3%, V=5.3%, RN=10.5%), cleaned site (I=89.5%, RN=10.5%), assembled injection device (I=47.4%, R=36.8%, V=15.8%), self-injected (I=31.6%, R=36.8%, V=15.8%, RN=15.8%) and disposed of device (I=21.1%, R=21.1%, RN=57.9%).

Many adolescents are interested in and capable of DMPA-SC self-administration with brief education and minimal assistance.