This might be of interest to some members. Paul Professor Paul Bywaters Emeritus Professor of Social Work Coventry University Priory Street, Coventry CV1 5FB 02476 795384 ________________________________ From: David Hock, USA [mailto:[log in to unmask]] Sent: Wed 27/02/2008 22:03 To: HIF-net Subject: [hif-net] Research Briefs on Contraceptive Technology from Family Health International Contraceptive and Reproductive Health Technologies Research and Utilization Program Quarterly Briefs, Oct-Dec 2007 Research * Community-Based Workers Can Administer Safe, High-Quality Contraceptive Injections * Research from Three Developing Countries Confirms Hierarchy of Contraceptive Effectiveness * Risk of Pregnancy Should be Considered When Designing Effectiveness Trials of HIV-Prevention Drugs Research to Practice * Family Health International Updates "Underused Research Findings" * Indian Government Takes Steps to Revitalize Intrauterine Device Services * Training on Good Clinical Practice Held in the Dominican Republic _____________________________________________ Research: Community-Based Workers Can Administer Safe, High-Quality Contraceptive Injections Community-based reproductive health workers in a rural African setting can provide contraceptive injections as safely and effectively as local clinic-based workers, according to results of a USAID-supported study in Uganda. Community-based workers in Nakasongola district, Uganda, were trained in counseling skills, health screening for injectable users, techniques for safe injections, and proper waste disposal. They then spent two weeks observing and practicing injections of depot medroxyprogesterone acetate (DMPA) in supervised medical settings, after which they began providing injections on their own. Job aids provided during the training included a checklist for client screening and an illustrated counseling tool. Scientists from Family Health International, the Uganda Ministry of Health, and Save the Children/USA interviewed 777 clients 13 weeks after their first contraceptive injection. The care received from the community-based workers was compared with the care received from nurses and midwives in local health centers. Care was evaluated according to whether a second injection was obtained, continuation rates and reasons for discontinuation, client satisfaction, and recall of key counseling messages, among other measures. Results of the study showed no significant difference in continuation rates or client satisfaction between the two groups. Clients of the community-based workers had a slightly higher rate of problems at the injection site than clients of clinic-based workers, but this difference was not significant and decreased over time (presumably because of improved injection technique with practice). Interviewers noted that clients in both groups had difficulty retaining key counseling messages such as common side effects and method-related health problems for which medical attention should be sought. The authors of the study conclude that the practice of contraceptive injections by community-based reproductive health workers should be scaled up throughout Africa and elsewhere. Special emphasis should be placed on promoting quality and access through training, the use of job aids, and solid logistical support systems. To read more about this topic, see: http://www.who.int/bulletin/volumes/85/10/07-040162/en/index.html Source Stanback J, Mbonye AK, Bekiita M. Contraceptive injections by community health workers in Uganda: a nonrandomized community trial. Bull World Health Organ 2007;85(10):768-773. Research from Three Developing Countries Confirms Hierarchy of Contraceptive Effectiveness Results from a recent analysis supported by USAID and the National Institutes of Health underscore the counseling message that when it comes to preventing pregnancy, injectable contraceptives are more effective than combined oral contraceptive pills, which are more effective than condoms. The analysis was conducted by scientists at Family Health International, Makerere University in Uganda, the University of Zimbabwe, and Chiang Mai University in Thailand, and was based on data collected between November 1999 and January 2004. The research involved 5,224 women from Uganda, Zimbabwe, and Thailand who had participated in a study on the association between hormonal contraception and HIV acquisition. Results showed that for a woman using an injectable contraceptive, the risk that she would become pregnant within one year of starting the method was 1 percent or less in all three countries. In Uganda and Zimbabwe, the risk that a user of oral contraceptive pills would become pregnant was at least 10 percent. For women intending to use injectables, pills, or condoms at the beginning of the study, the annual pregnancy risk for condoms was by far the highest: as high as 30 percent in Uganda. The risk of pregnancy among users of pills or condoms was substantially lower in Thailand than in the African countries, but the investigators were not able to clarify the reason for this discrepancy. Study investigators support contraceptive counseling that clarifies the different levels of pregnancy protection afforded by different methods, and that informs women that their experience with a particular form of contraception may vary from the average or typical experience. Furthermore, the investigators urge counselors to provide women with tailored counseling, to allow them to make more informed contraceptive choices. To read more about this topic, see: http://www.ncbi.nlm.nih.gov/pubmed/17978111?dopt=3DAbstract Source Steiner MJ, et al. Pregnancy risk among oral contraceptive pill, injectable contraceptive, and condom users in Uganda, Zimbabwe, and Thailand. Obstet Gynecol 2007;110(5):1003-1009. Risk of Pregnancy Should be Considered When Designing Effectiveness Trials of HIV-Prevention Drugs A recently published article, supported by USAID and the National Institute of Child Health and Human Development, summarizes key issues related to pregnancy that should be carefully considered during the design of trials that test the effectiveness of HIV-prevention drugs. The issues were raised during several meetings of HIV-prevention researchers and selected experts. Because trials that test the effectiveness of HIV-prevention drugs require the enrollment of sexually active women of reproductive age, study participants are simultaneously exposed to the risks of HIV and pregnancy. The risk of pregnancy in particular has important - yet often complicated - implications for how trials are conducted, and how data are interpreted. For example, trial organizers need to protect participants by preventing pregnancies or by identifying pregnancies before a fetus is unnecessarily exposed to a study drug. Preventing pregnancies is also important because the results of a trial can be skewed when pregnant women stop taking a study drug. Yet lack of access to contraception can be a problem. Also, some contraceptive methods could alter the effectiveness of a study drug, or their side effects could mimic a drug's toxic effects. Other major issues identified during the meetings include ensuring the safety of trial participants; concerns related to the interpretation of data when participants become pregnant; strategies for preventing pregnancy; and the reliable, safe identification and care of pregnant women during trials. To read more about this topic, see: http://www.popline.org/docs/322525 Sources Raymond EG, Taylor D, Cates W, et al. Pregnancy in effectiveness trials of HIV prevention agents. Sex Transm Dis 2007;34(12):1035-1039. ___________________________________________ Research to Practice: Family Health International Updates "Underused Research Findings" As part of its USAID-supported Research to Practice Initiative, Family Health International (FHI) has updated its working summary of "underused research findings." These are findings from research and programs that FHI believes would improve family planning and reproductive health services if they were more widely incorporated into policies and programs in the developing world. Updated in November 2007, the new summary covers 16 topics - including five new ones on youth, implants, contraceptive continuation, male circumcision and HIV, and contraceptive counseling and job aids. FHI is committed to promoting use of the full summary of findings, which can be found at: http://www.fhi.org/en/RH/Programs/RtoP/underusedres.htm Indian Government Takes Steps to Revitalize Intrauterine Device Services With support from USAID, Family Health International recently conducted a technical symposium aimed at developing strategies to expand intrauterine device (IUD) services in India. The symposium was held in Lucknow, India on October 3-4, 2007. Additional partners in the efforts to revitalize IUD services in India include USAID, the Indian Ministry of Health and Human Welfare, the government of Uttar Pradesh, Constella Futures, the State Innovations in Family Planning Services Project Agency, JHPIEGO, and the Population Council. The symposium welcomed 65 participants, including senior ministry and government officials, representatives from sponsors and nongovernmental organizations, as well as public and private practitioners. Program participants represented areas crucial to the conference goals, with expertise in clinical care, research, capacity building, program implementation, information, education, and communication. Symposium participants recommended the following strategies for expanding IUD services: * Service delivery can be improved by supervising providers in a facilitative, not punitive, manner; by insuring that providers are recognized based on superior performance; and by working to increase the rate of IUD provision in the immediate post-partum period. * Improving human resources will require competency-based training. Monitoring is also needed to insure that this type of training is consistently translated into actual practice. Furthermore, educational programs for medical personnel at all levels should emphasize family planning methods, particularly the IUD. * Well-designed community-awareness campaigns should be the focus of communication efforts to change behaviors. Additionally, all categories of IUD providers should receive comprehensive training to improve their communication and counseling skills. * Public-private partnerships will need to be strengthened, perhaps using the successes of the Hindustan Latex Family Planning Promotion Trust as a model. Multiple channels and associations should be employed in an effort to improve on the general awareness of family planning and IUDs. This may be accomplished by studying those factors that further motivate private-sector involvement in IUD services, as well as by engaging the Federation of Obstetrics and Gynecology Societies of India in the training and quality improvement of private providers. To find out more about this topic, see: http://www.maqweb.org/iudtoolkit/index.shtml Training on Good Clinical Practice Held in the Dominican Republic Forty-six nurses and physicians affiliated with Profamilia in the Dominican Republic participated in a USAID-supported training on Good Clinical Practice (GCP) on October 13, 2007. Good Clinical Practice is a set of international standards that pertain to clinical trials involving human subjects. Led by Family Health International, the training covered topics essential to conducting trials according to GCP regulations of the U.S. Food and Drug Administration and the GCP guidelines of The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use. Topics discussed during the training included: * Principles of GCP * Responsibilities of trial investigators * Source documentation (i.e., all of the original documents, data, and records generated during the course of a trial) * Responsibilities of institutional review boards * Responsibilities of sponsors * Clinical study protocols * Investigator brochures * Essential documents (i.e., those that help in evaluating how a study is conducted and determining the quality of the data produced) Family Health International offers courses on GCP to train its sponsors and partner organizations on how to conduct ethical trials. Profamilia provides extensive services throughout the Dominican Republic, including a full range of family planning activities, a very successful social-marketing program, and a biomedical and demographic research project. For more information about the foundations of research ethics, including GCP, see: http://www.fhi.org/training/en/Retc/s2pg8.htm ________________________________________ Compiled by Rosalyn Carson-DeWitt and Kerry Wright Aradhya. For more information, contact [log in to unmask] --------------------------------------- [HIF-net profile: David Hock works for Family Health International where he is responsible for electronic dissemination of information on FHI's research and publications through mass e-mails, listserv postings and the corporate Web site. [log in to unmask]] HIF-net: working together to improve access to reliable information for health researchers and health professionals in developing and transitional countries. Send list messages to <[log in to unmask]>. To join or leave the list, send an email to <[log in to unmask]>. If joining, please include name, organization, country, and brief description of professional interests. Archive at: http://www.dgroups.org/groups/HIF-net/ -------------------------------------------------------- NOTICE This message and any files transmitted with it is intended for the addressee only and may contain information that is confidential or privileged. Unauthorised use is strictly prohibited. If you are not the addressee, you should not read, copy, disclose or otherwise use this message, except for the purpose of delivery to the addressee. Any views or opinions expressed within this e-mail are those of the author and do not necessarily represent those of Coventry University.