Provision of DMPA-SC for self-administration in different practice settings during the COVID-19 pandemic: data from providers across the United States.

Depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) can be prescribed through telemedicine and self-administered, but data about availability particularly during COVID-19 pandemic are limited. This study assessed changes in availability of DMPA-SC for self-administration during the pandemic. This study used survey data from a convenience sample of US providers engaged in contraceptive care and participating in a CME-accredited contraceptive training (April 2020-April 2022; n=849). Providers were recruited from across 503 clinics, including primary care and family planning clinics, public health departments, college and school-based health centers, independent abortion care clinics, and outpatient clinics in hospital settings. Measures included availability of DMPA-SC for self-administration pre-pandemic and during the pandemic and use of telemedicine. We used Poisson regression models and cluster robust errors by clinic, adjusting for region, time of survey, and clinic size, to assess clinic availability of DMPA-SC for self-administration by practice setting. Compared to pre-pandemic (4%), availability of DMPA-SC for self-administration increased significantly during the pandemic (14%) (adjusted prevalence ratios [aPR] 3.43, 95% CI [2.43-4.85]). During the pandemic, independent abortion clinics were more likely to offer DMPA-SC for self-administration compared to primary care clinics (aPR 2.44, 95% CI [1.10-5.41]). Clinics receiving Title X funds were also more likely to provide DMPA-SC for self-administration during the pandemic compared to other clinics (aPR 2.32, 95% CI [1.57-3.43], and more likely to offer DMPA-SC for self-administration through telemedicine (aPR 2.35, 95% CI [1.52-3.63]. Compared to the early pandemic (April-September 2022), telemedicine access to DMPA-SC for self-administration was highest during the later pandemic time-period (October 2021-April 2022) (aPR 2.10, 95% CI [1.06-4.17]). Availability of DMPA-SC for self-administration significantly increased during the pandemic with differences by practice setting and Title X funding. However, overall method availability remains persistently low. Despite increased availability of DMPA-SC for self-administration among US contraceptive providers during the COVID-19 pandemic, there remains a need to train providers, educate patients, and remove barriers to ensure broader availability of this method across different practice settings.

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Copyright © 2023. Published by Elsevier Inc.