Getting Up to Date with What Works: A Systematic Review on the Effectiveness and Safety of Task Sharing of Modern Methods in Family Planning Services

Table 2

Summary of findings on self-injection of DMPA-SC.

Is self-injection of injectable contraceptives safe and effective compared to usual care?
Patient or population: injectable contraceptive users; Setting: Texas and New Jersey (USA), New York (USA), Malawi, Senegal, Uganda (Africa); Intervention: self-injection; Comparison: usual care
Outcomes	Anticipated absolute effects (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with usual care	Risk with self-injection
Contraceptive discontinuation (12 months) (discontinuation)	51 per 100	29 per 100 (19 to 44)	RR 0.56 (0.37 to 0.86)	1142 (3 RCTs)	⨁⨁⨁◯; Moderate^a
Contraceptive discontinuation (12 months) (discontinuation)	31 per 100	19 per 100 (14 to 25)	RR 0.62 (0.47 to 0.82)	2398 (2 observational studies)	⨁⨁⨁◯; Moderate^b,c
Overall side effects after 3rd injection (side effects) assessed with: self-reporting	23 per 100	19 per 100 (17 to 22)	RR 0.86 (0.77 to 0.96)	2052 (2 observational studies)	⨁⨁◯◯; Low^d
Nondesired pregnancies (pregnancy rate) assessed with: urine pregnancy tests (1 study), self-reporting (1 study)	Ten nondesired pregnancies occurred: 6 in the control group and 3 in the intervention group. Results suggest no or little difference between control and intervention			1132 (2 RCTs)	⨁◯◯◯; Very low^e,f
Nondesired pregnancies (pregnancy rate) assessed with: not stated	Six unplanned pregnancies were reported, half in each arm. Results suggest no or little difference between control and intervention			2398 (2 observational studies)	⨁◯◯◯; Very low^b,f
The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).; CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence; High certainty: We are very confident that the true effect lies close to that of the estimate of the effect; Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect; Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

^aThe proportion of the variability in effect estimates that is due to true heterogeneity rather than chance is important . ^bDowngraded because of concerns over residual confounding. ^cThe comparison group here was provider administration of DMPA-IM instead of DMPA-SC. We did not downgrade the evidence because DMPA-IM and DMPA-SC are considered very similar aside the route of administration. ^dRisk of bias assessment was “serious” for both studies on this outcome per ROBINS-I. ^eOne in 2 studies reported important missing data (>15%) in the outcome with clear imbalance between intervention and control groups. ^fBecause of the few numbers of events, effect measures were not computed in individual studies.