CDC Adopts WHO Recommendations for Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the WHO recommendation for self-administration of DMPA-SC 2. Describe the review undertaken by CDC for self-administration of DMPA-SC and the final recommendation
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours.
Designated for 0.25 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a progestin-only injectable contraception method that is FDA approved. Recommendations regarding eligibility and us of DMPA-SC are included in U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) and is the same as for IM route. DMPA is most commonly used by younger women (aged 15 to 24 years), non-Hispanic Black women, and women with lower income. The CDC reviewed the literature and available data to determine whether self-administered DMPA-SC should be be made available as per WHO 2019 guidance.
WHO Guidance (2019)
WHO recommends that self-administered injectable contraception should be made available as an additional approach to deliver injectable contraception to persons of reproductive age
Evidence was considered to be of moderate-certainty and that the benefits of self-administration outweighed any potential harms, resulting in a ‘strong’ recommendation
The WHO approach is in line with shared decision making models
CDC Evidence Review
Literature review included RCTs and observational studies that
Compared self-administered DMPA-SC with provider-administered DMPA-SC or DMPA-IM
Provided outcomes that included: Pregnancy | Side effects or adverse events | Initial use of injectable contraception | Continuation rate of injectable contraception | Self-efficacy | Knowledge, and empowerment | Social harms
Risk of bias was evaluated using The Cochrane Collaboration tool for RCTs and the Evidence Project tool for observational studies
Updated the search to identify additional articles published through January 15, 2021
Considered global information on values and preferences about self-administration of DMPA-SC and information on implementation of self-administered DMPA-SC in the United States
Invited 18 external experts to serve as ad hoc reviewers of the evidence and the WHO recommendation
2019 systematic review identified six studies: 3 RCTS and 3 prospective studies
Higher rates of continuation were observed with self-administered DMPA-SC
Pregnancy rates were low overall (≤1%) and did not differ between self-administered and provider-administered groups.
No other side effects or adverse events were increased with self-administration
In an additional secondary analysis of one study, 12-month continuation rates were similar for self-administered DMPA-SC among younger (aged 18 to 24 years) and older (aged ≥25 years) participants
Based on the above review, including a focus on the US data
CDC adopted the WHO recommendation for self-administered DMPA-SC, which was guided by evidence that the practice increases contraceptive continuation and has equivalent rates of pregnancy, side effects, and associated adverse events compared with provider-administration
The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan