Strategies for Successful Promotion and Implementation of Contraceptive Method Mix in MTN-020/ASPIRE: The Why and How at Kampala Site

Background: To enroll in ASPIRE; participants must be on an effective method of contraception ranging from COC DMP Implants IUCD and sterilization. In Uganda there is a low contraceptive prevalence and a high unmet need (43%) of use. This was reflected in the VOICE study where uptake for Long Acting Reversible Contraceptive (LARC) was only 6%. In an attempt to enhance Contraceptive Method Mix (CMM) in ASPIRE the Kampala team describes how this was made successful. Methods: Preparatory activities started prior to site activation with formation of the Contraceptive Action Team (CAT) under the leadership of the MTN Contraceptive Steering Committee with the aim of exploring misconceptions identifying barriers and increasing LARC uptake. Following this 2 members were declared contraceptive experts and charged with spearheading CMM. These liaised with existing f/planning clinics to train study counselors on counseling messages and clinicians in inserting and removal of LARCs. We started linkages with the community and satellite clinics to demystify myths and misconceptions using flip charts and models and the community found this exciting. All methods were made available onsite assigned a nurse for logistics and created a room for providing the LARC. Results: There is an increase in the use of IUCDs and implants and a decrease in injectables and pill use after the inception of CAT. Previously contraception was limited to COCs and DMPA. LARCs (Implants IUCD) and tubal ligation were being offered at the nearby Hospital. Now all methods are available on-site except tubal ligation. Conclusions: Method Mix and expansion of LARC methods is possible in a low resource limited setting. For success information is key ongoing refresher training regular evaluations peer support good political will ongoing participant care and counseling are all important.