Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana - 08/07/21
, Sarah Wood, MD, MSHP 1, 2, 3, 4, Neo Moshashane, BA 5, 6, Kehumile Ramontshonyana, BA 5, 6, Christina Amutah, BA 3, Pegah Maleki, MSW, LSW 2, Claire Howlett, BS 2, Merrian J. Brooks, DO, MS 1, 4, Aamirah Mussa, MPH 5, Dipesalema Joel, MBBChBAO, B Med Sc, MRCPI 7, Andrew P. Steenhoff, MBBCh, DCH, FCPaed 3, 4, 6, 7, Aletha Y. Akers, MD, MPH 1, 2, 3, Chelsea Morroni, MBChB, MPH, PhD 5, 6, 8ABSTRACT |
Study Objective |
Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.
Design |
Cross-sectional mixed methods.
Setting |
Gaborone, Botswana.
Participants |
Twenty sexually active AGYW ages 18-24 years; 20 health system stakeholders.
Interventions |
Surveys and semistructured interviews grounded in the Consolidated Framework for Implementation Research.
Main Outcome Measures |
Themes reflecting barriers and facilitators of LARC implementation.
Results |
The median age for AGYW was 22 (interquartile range, 21-23) years. Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators of LARC implementation spanned factors at each Consolidated Framework for Implementation Research domain: (1) LARC characteristics like side effects; (2) the clinics’ inner settings, including availability of youth-friendly services; (3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes, and beliefs about LARCs; (4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and (5) the implementation process level such as the availability of free or low-cost LARCs.
Conclusion |
We identified multilevel, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.
Il testo completo di questo articolo è disponibile in PDF.Key Words : Long-acting reversible contraceptives, LARC, Implant, IUD, Adolescent, Botswana
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| Dr. Akers has received research funding support in the past 12 months from Bayer Healthcare for an investigator-initiated grant, and the Templeton Foundation, and has been a paid consultant for the Merck HPV Advisory Board, Mylan Pharmaceuticals Women's Health Advisory Board, and for Medicines360. The remaining authors indicate no conflicts of interest. |
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| This work was presented, in part, as a poster on October 4, 2019, and as an oral presentation on October 10, 2020, at the Children's Hospital of Philadelphia Pediatric Global Health Conference, Philadelphia, Pennsylvania. |
Vol 34 - N° 4
P. 504-513 - agosto 2021 Ritorno al numero
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