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Single-use injectable devices address barriers, concerns.

The ongoing development of various single-use injection devices may make injectable contraceptive provision safer. One such device is called SoloShot FX. Since September 2002, it has been packaged with all U.S. Agency for International Development (USAID) shipments of the three-month, progestin-only injectable depot-medroxyprogesterone acetate (DMPA). Developed by the U.S.-based Program for Appropriate Technology for Health (PATH) with support from USAID, SoloShot FX has a metal clip that locks the plunger after a single use and is packaged with a detachable needle that cannot be attached to any other type of syringe. (1) To encourage safe disposal of used syringes, all USAID shipments of SoloShot FX and DMPA include a special container in which syringes, needles, and other contaminated materials can be discarded. Notably, SoloShot FX causes less pollution than most standard syringes when it is burned (after disposal), since it does not contain a black rubber piston seal.

Another such device, also developed by PATH with support from USAID and commercially produced and distributed by U.S.-based BD (Becton, Dickinson and Company), is called Uniject. This plastic device houses hormones, needle, and syringe together in one small sealed pouch. Such an arrangement makes Uniject easy to transport outside of a clinic setting and particularly easy to administer, even by paramedical or trained nonmedical personnel. Like the SoloShot FX, Uniject was specifically designed so it could not be refilled or used again. An additional and important feature of Uniject is that it is prefilled with a single dose of hormones so the correct dose is always administered.

These new devices for injecting contraceptives address several concerns about, and barriers to, the use of injectable contraceptives, which more than 12 million women worldwide use. First, in some resource-poor settings or where contraceptive supplies are limited, needle reuse--which can put clients at risk for blood-borne infections such as HIV--sometimes occurs. The use of single-use injection devices would minimize this risk in both clinic and community-based distribution programs. (See article, page 12.) Second, for many women, travel to clinics to receive injections is difficult and expensive. (2) But community-based workers could more easily give injections if Uniject were available for them. "We see technologies like Uniject enhancing the ability to take interventions to clients through outreach activities--clients who would otherwise not be reached," says Steve Brooke, PATH senior program officer, business development and commercialization.

With support and technical assistance from the World Health Organization and PATH, the Universidade Estadual de Campinas (UNICAMP), Centro de Pesquisas das Doencas Materno-infantis de Campinas (CEMICAMP), Intrah, and colleagues evaluated in Brazil the administration of the one-month, combined injectable Cyclofem using Uniject versus standard syringes. A study including 20 registered and auxiliary nurses and 135 injectable users from five reproductive health clinics there showed that nurses could easily administer Cyclofem in the Uniject device.3 Ninety percent of the nurses said the device was easy to activate and inject, and all said it was easy to store and transport.

The same Brazilian study showed high rates of acceptability among users. Women in the study reported little pain during injections, and almost all said they would receive another Uniject injection. An additional study from Brazil showed that even self-administration was feasible and acceptable to some women: More than 90 percent of 56 injectable users were able to self-administer Uniject/Cyclofem correctly, and half said they wished to continue injecting the contraceptive themselves. (4)

A similar study has been conducted by public-sector agencies in Mexico; results are pending. In the meantime, the Mexican company Aplicaciones Farmaceuticas has acquired regulatory approval to sell Uniject/Cyclofem in the public and private sectors. The company plans to do so once it is certain that its high-volume manufacturing process will reliably meet demand for the product, says PATH's Brooke. The U.S.-based company Pharmacia is also considering the feasibility of Uniject as a delivery system for DMPA. Meanwhile, USAID is supporting the application of Uniject for the delivery of either Cyclofem or DMPA, and hopes to begin testing this approach in 2003.

REFERENCES

(1.) HealthTech. Introducing Auto-Disable Syringes and Sharps Disposal Containers with DMPA. Seattle, WA: Program for Appropriate Technology in Health, 2001. Available: http://www.path.org/files/SI_CNVP15904_English.pdf

(2.) Bahamondes L, Marchi NM, Nakagava HM, et al. Self-administration with UniJect of the once-a-month injectable contraceptive Cyclofem. Contraception 1997;56(5):301-4.

(3.) Bahamondes L, Marchi NM, de Lourdes Cristofoletti M, et al. Uniject as a delivery system for the once-a-month injectable contraceptive Cyclofem in Brazil. Contraception 1996;53(2):115-19.

(4.) Bahamondes, Marchi, Nakagava.
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Article Details
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Author:Shears, Kathleen Henry
Publication:Network
Article Type:Brief Article
Geographic Code:00WOR
Date:Mar 22, 2003
Words:759
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