The Progestin Medroxyprogesterone Acetate Affects HIV-1 Production in Human Lymphoid Tissue Explants in a Dose-Dependent and Glucocorticoid-like Fashion

The association between the use of the injectable contraceptive depot medroxyprogesterone acetate and HIV-1 susceptibility has been addressed mainly in respect to the changes occurring in the female genital mucosa and blood. However, one of the main sites of HIV-1 pathogenesis is lymphoid organs. To investigate the immunoregulatory effect of medroxyprogesterone acetate (MPA) at this site, human tonsillar tissue explants were infected ex vivo with either a CCR5 (BaL) or CXCR4 (LAI) HIV-1 variant and the release of p24gag and cytokines was measured in culture supernatant. The response to MPA was compared with that elicited by treatment with progesterone (P4) and dexamethasone (DEX), which selectively binds the glucocorticoid receptor, in donor-matched explant cultures. MPA treatment reduced the replication of both tested HIV-1 strains as well as the production of the mediators of inflammation IL-1β, IL-17A and CCL5, but not CCL20, in a similar way to DEX, whereas P4 had no effect on HIV-1 replication. The magnitude of both MPA and DEX-mediated responses was proportional to the length of exposure and/or administered dose. Blockage of the progesterone and glucocorticoid receptors with mifepristone abolished all observed changes in HIV-1 and cytokine production, and was associated with increased IL-22 levels in HIV-infected explants. Our data indicate that elevated doses of MPA may affect the immune responses in lymphoid tissue in a glucocorticoid-like fashion with an immediate impact on local HIV-1 replication.

Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

Background The low utilisation of modern contraceptives in many low- and middle-income countries remains a challenge. Patent medicine vendors (PMVs) that operate in the informal health sector, have the potential to address this challenge. Between 2015 and 2018, the Population Council, in collaboration with the Federal and State Ministries of Health and the Pharmacy Council of Nigeria, trained PMVs in six states to deliver injectable contraceptive services. Outcome evaluation demonstrated increased client uptake of injectable contraceptive services; however, there is limited information on how and why the intervention influenced outcomes. This study was conducted to elucidate the processes and mechanism through which the previous intervention influenced women’s utilisation of injectable contraceptive services. Methods The study utilised a mixed methods, convergent parallel design guided by the UK Medical Research Council framework. Quantitative data were obtained from 140 trained PMVs and 145 of their clients in three states and 27 in-depth interviews were conducted among relevant stakeholders. The quantitative data were analysed descriptively, while the qualitative data were analysed thematically. Results The results revealed that even after the completion of the PMV study which had a time-bound government waiver for injectable contraceptive service provision by PMVs, they continued to stock and provide injectables in response to the needs of their clients contrary to the current legislation which prohibits this. The causal mechanism that influenced women’s utilisation of injectable contraceptives were the initial training that the PMV received; the favourable regulatory environment as demonstrated in the approval provided by government for PMVs to provide injectable contraceptives for the duration of the study; and the satisfaction and the confidence the female clients had developed in the ability of the PMVs to serve them. However, there were gaps with regards to the consistent supply of quality injectable contraceptive commodities and in PMVs use of job aids. Referral and linkages to government or private-owned facilities were also sub-optimal. Conclusion PMVs continue to play important roles in family planning service provision; this underscores the need to formalize and scale-up this intervention to aid their integral roles coupled with multi-faceted initiatives to enhance the quality of their services.

DESCRIPTION OF MENSTRUAL CYCLE DISORDERS IN 3 MONTHS INJECTABLE CONTRACEPTIVE USERS

3-month injectable contraception is a hormonal contraceptive that is widely used by women of childbearing age (WUS) because it is very effective in preventing pregnancy, and includes the Intermediate-term Method. The use of 3-month injectable contraceptives also has drawbacks or side effects, one of which is menstrual cycle disorders. The purpose of this study was to determine the description of menstrual cycle disorders in users of 3-month injectable contraceptives.This study used a descriptive design. The population in this study was women of childbearing age who used injection contraception for 3 months at the sub-health center of Tanjung Village. The total population in this study was 48 samples. The sampling technique was carried out by the total sampling technique. The analytical method used in this study was descriptive statistics.The results of the study showed that using 3-month injectable contraceptives were found that 29 respondents (60.4%) experienced amenorrhea, 15 respondents (31.3%) spotting, and 4 respondents (8.3%) did not experience menstrual cycle disorders.Most users of 3-month injectable contraceptives experience amenorrhea

Knowledge, Perception, and Practice of DMPA-SC/Self-Injectable Contraceptive among Women: Findings from Mixed-Method Study in South-West and North-Central, Nigeria

Depot-Medroxyl-Progesterone-Acetate-Subcutaneous/Self Injection (DMPA-SC/SI) is an intentional approach used by the Nigerian government to improve the coverage rate of contraceptives method-mix. In this study, the knowledge, practice, and determinants of use of DMPA-SC/SI among women in North-Central and South-West, Nigeria, was assessed. A cross-sectional health facility study was conducted across four Nigerian states. Structured pretested questionnaires were used to elicit information from 844 women within reproductive age. Twenty focused group discussions and 40 In-depth interviews (IDIs). Descriptive statistics were used to analyze the characteristics of the women. Multivariate logistic regression was used to examine the determinants of the current use of DMPA-SC /SI. Statistical analyses were set at 5%. Recorded voices were transcribed in full and analyzed using literary methods. About 89.5% of respondents reported ever heard family planning; 97.6% reported heard DMPA-SC; 83.2% reported ever use family planning; 95.7% reported current use of family planning; 94.3% reported ever use DMPA-SC, and 46.5% reported ever use DMPA-SC/SI. The reason for the use of DMPA-SC/SI was because it was easy to use, effective and self-administered. The factors that discourage women from using DMPA-SC/SI were mainly fears associated with side effects, for and fear of SI-self-injury. The logistic regression results showed that those residing in a rural part of the country were less likely to use DMPA-SC/SI. The government should scale up this model nationally, including rural and hard-to-reach communities with public awareness programmes, public sensitization, and refresher training to improve on Provider’s counselling skills. Keywords: Knowledge, Practice, Self-injectable contraceptive.

Hubungan Antara Lama Penggunaan Kontrasepsi Suntik 3 Bulan dengan Peningkatan Berat Badan di PMB I

Metode kontrasepsi yang paling banyak digunakan oleh peserta Keluarga Berencana (KB) aktif di Indonesia adalah suntikan (63,71%). Selain memiliki manfaat, alat kontrasepsi suntik juga memiliki efek samping salah satunya peningkatan berat badan yang sering dikeluhkan oleh akseptor KB suntik 3 bulan. Tujuan penelitian ini adalah untuk mengetahui Hubungan antara Lama Penggunaan KB Suntik 3 Bulan dengan Peningkatan Berat Badan di Praktik Mandiri Bidan (PMB) “I”. Penelitian ini merupakan penelitian analitik dengan rancangan cross sectional. Sampel dalam penelitian adalah 104 orang akseptor KB suntik 3 bulan yang rutin melakukan suntik KB tahun 2019. Data yang digunakan dalam penelitian ini adalah data sekunder yang diperoleh dari rekam medik. Analisa data dilakukan dengan menggunakan analisa univariat dan analisa bivariat. Akseptor KB suntik 3 bulan dengan lama penggunaan paling tinggi yaitu 1 tahun sebanyak 33 responden (31.7%) dan peningkatan berat badan paling tinggi yaitu 2-5 kg sebanyak 46 responden (48.9%). Hasil analisis bivariat menunjukkan penggunaan KB suntik 3 bulan dengan peningkatan berat badan dengan nilai Likelihood Ratio 0.000 (α < 0,05). Sehingga dapat disimpulkan bahwa ada hubungan antara lama penggunaan KB suntik 3 bulan dengan peningkatan berat badan. Background: The contraceptive method most widely used by active family planning participants in Indonesia is injection (63,71%). Besides having the benefits of injection contraception, it also has side effects, one of which is the cause of weight gain. Purpose: The purpose of this research is to know The Correlation Between the Long Use Contraceptive 3 Month Injection and Weight Gain at Midwife Independent Practice “I”. Methods: This research is analytic research with cross-sectional design. The samples of this research are 104 people who routinely use contraceptive 3-month injection. The data that is used in this research is secondary data which is gotten from medical records and registration books. The analysis is done by using univariate analytic and bivariate analytic. Result: 3 months injectable acceptors with the highest duration of use, 1 year, were 33 respondents (31.7%) and the highest weight gain was 2-5 kg as many as 46 respondents (48.9%). The results of the bivariate analysis showed the use of 3 months of injectable contraceptive with an increase in body weight with a Likelihood Ratio 0.000 (α < 0,05). So, it can be concluded that there is a correlation between the duration of use 3 months of injectable contraceptives and weight gain.

Multiple Logistic Regression Model for Determinants of Injectable Contraceptive Uptake Among Women of Reproductive Age in Kenya

Objective: The recent increase in the uptake of injectable contraceptives has occurred at the expense of the other modern contraceptive methods but the knowledge gap still exists on modeling dynamics and determinants associated with the use of the injectable. This study sought to model for injectable contraceptive usage to bridge the knowledge gap on the use of injectable contraceptives among women of childbearing age in Kenya. Materials and methods: Analytical cross-sectional study design was adopted. Secondary data for women collected during the (Performance Monitoring for Action) PMA2020 survey was used. PMA2020 survey used multistage stratified sampling with urban-rural representation. To establish the factors associated with the uptake of injectable contraceptives, a multiple logistic regression model was fitted using Stata version 13 and R version 3.5.3 statistical software. Hosmer-Lemeshow Test statistic was used to evaluate the goodness of model fit in predicting injectable contraceptive usage. Results: Multivariable analysis showed that women with post-primary/vocational levels of education were 54% less likely to use an injectable contraceptive compared to those who had no education at all. Hosmer-Lemeshow (HL) goodness of fit test statistic indicated that the model was a good fit for prediction. Education, marital status, wealth quintile, place of residence and number of births were significant predictors of the injectable contraceptive uptake among women of reproductive age in Kenya. Conclusion: The findings of this study will inform the design of targeted interventions aimed at addressing the increasing demand for injectable devices among women of reproductive age in Kenya.

USE OF KB INJECTABLE DEPO MEDROXY PROGESTERONEACETATE (DMPA) IN GEMURUH VILLAGE, KUNDUR DISTRICT KARIMUN REGENCY

Background : According to WHO, the number of injectable contraceptive use worldwide is as much as 4,000,000 or about 45%. In the United States, the number of injectable contraceptives is 30%, while in Indonesia, injection contraception is one of the most popular contraceptives. Contraception in Indonesia is the most interested, namely injection contraception at 34.3% (RISKESDAS, 2013). Method : The design that researchers use is a descriptive design that aims to find out the picture. The research data collection was conducted at the Independent Practice Midwives. The population is all active family planning acceptors recorded in the medical record and new acceptors. Sampling was done by using the total sample method. The type of instrument used in this research is a questionnaire, which is a written question addressed to the respondent to be answered. Univariate analysis is used to explain or describe the characteristics of each variable being studied by displaying an overview of the frequency distribution. Result : It is known that the duration of use of DMPA injection contraceptives ≥ 1 year was 27 acceptors (77.1%) while for the duration of use ≤ 1 year there were 8 acceptors (22.9%). Congclusions : It is known that the duration of use of DMPA injection contraceptives ≥ 1 year was 27 acceptors (77.1%) while for the duration of use ≤ 1 year there were 8 acceptors (22.9%).