在许多国家/地区注册了自行施用的仓库醋酸甲羟孕酮皮下注射避孕(DMPA-SC)。它显示出改善避孕方法的巨大潜力,延续,和自主性。然而,推出这种新的有效干预措施面临挑战,在扩大规模过程中遇到了重大的实施问题。
为了描述扩大自我管理DMPA-SC的实施策略和障碍,主持人,以及这些计划的结果。
最近的指导方针,包括用于范围审查的系统审查和荟萃分析(PRISMA)扩展的首选报告项目,用于设计和报告这篇综述。如果一篇文章或报告报告的干预措施可以扩大自我管理的DMPA-SC实施或其促进者,则有资格纳入。障碍,或结果。我们搜索了六个电子数据库和灰色文献,以查找合格的文章和报告。两名审阅者独立筛选了文档标题,摘要,和全文来识别合格的文件。使用结构化形式提取数据。使用卫生系统的有效实践和组织(EPOC)分类法框架进行主题分析,数据以叙事方式呈现。
在检索到的755个文档中,这次审查包括34个。所包括的大多数文件是多国报告(n=14),所有文件均在过去5年(2018-2021年)内发布。本综述确定了报告所有EPOC领域干预措施的文件。报告最多的干预措施是:卫生工作人员干部之间的任务共享,从事领导,鼓励政策,培训和教育,DMPA-SC需求生成,整合到现有程序中,改善筹资机制,与发展伙伴合作,加强供应链。主要障碍是资金欠佳,人力资源不足,DMPA-SC物流供应不足。放大结果的证据很少。
本范围审查报告了各国和项目采用的各种干预措施来扩大DMPA-SC的自我管理,但对扩大结果的证据很少。此次审查的证据可以帮助设计更好的计划,以改善获得优质计划生育服务的机会,以实现可持续发展目标(SDG)的目标3.7。然而,努力应集中在严格的实施研究上,以评估扩大的自我管理的DMPA-SC干预措施并报告其结果.
本次审查的协议已在protocols.io存储库中注册(https://www.protocols.io/view/a-protocol-for-a-scoping-review-of-implementation-x54v9yemmg3e/v1)。
Self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) is registered in many countries. It shows great potential for improving contraceptive access, continuation, and autonomy. However, there are challenges in rolling out this new efficacious intervention, and major implementation problems have been encountered during scale-up.
To describe the implementation strategies to scale up self-administered DMPA-SC and the barriers, facilitators, and outcomes of these programs.
Recent guidelines, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, were used to design and report this
review. An article or report was eligible for inclusion if it reported interventions that could scale up self-administered DMPA-SC implementation or its facilitators, barriers, or outcomes. We searched six electronic databases and the grey literature for eligible articles and reports. Two reviewers independently screened the document titles, abstracts, and full texts to identify eligible documents. Data were extracted using structured forms. Using the Effective Practice and Organization of Care (EPOC) taxonomy of health systems framework for thematic analysis, data were presented in a narrative approach.
Of the 755 retrieved documents, 34 were included in this
review. Most of the documents included were multi-country reports (n = 14), and all documents were published within the last 5 years (2018-2021). This
review identified documents that reported interventions in all EPOC domains. The most-reported interventions were: task-sharing amongst health workforce cadres, engaged leadership, encouraging policies, training and education, DMPA-SC demand generation, integration into existing programs, improved funding mechanisms, collaboration with development partners, and supply chain strengthening. The main barriers were suboptimal funding, inadequate human resources, and poor logistics supply of DMPA-SC. There was minimal evidence of scale-up outcomes.
This scoping
review reported a wide range of interventions employed by countries and programs to scale up DMPA-SC self-administration but minimal evidence of the scale-up outcomes. Evidence from this review can help design better programs that improves access to quality family planning services to achieve the Sustainable Development Goals (SDG) targets 3.7. However, efforts should focus on rigorous implementation research that assess scaled up self-administered DMPA-SC interventions and report their outcomes.
The protocol for this review was registered in the protocols.io repository ( https://www.protocols.io/view/a-protocol-for-a-scoping-
review-of-implementation-x54v9yemmg3e/v1 ).