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Objective: While self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) has well-documented benefits, uptake may be improved by addressing client concerns such as fear of self-injury and low self-efficacy. However, current training materials for family planning providers do not address these concerns. We used an iterative process with family planning providers and clients, male community leaders and partners, and stakeholders in Malawi to develop a counseling message addressing user-centered concerns about self-injection. We report on our testing of the effectiveness of this evidence-based message for increasing self-injection uptake in the context of full method choice. Methods: We randomized 60 public facilities across two districts in southern Malawi to orient their providers to the message (treatment) or not (control). After strengthening data quality, we extracted routine service delivery data from the facilities six months before and after introducing the message. We compared pre- and post-orientation trends for the treatment and control groups using generalized linear mixed models. We conducted eight focus group discussions with a sample of providers oriented to the message. Results: The message was feasible to implement and highly acceptable to providers. During June 2020–June 2021, 16,593 new clients used injectables in Mangochi district (52% DMPA-SC; 15% self-injected). In Thyolo district, 7,761 new clients used injectables during July 2020–July 2021 (29% DMPA-SC; 14% self-injected). We observed high variability in number of clients and self-injection uptake across facilities and over time, indicating inconsistent offering of self-injection. In both districts, we found significant increases in self-injection in treatment facilities after message introduction. However, this increase was not sustained, especially when DMPA-SC was unavailable or about to expire. Conclusion: Based on the study findings, we recommend the evidence-based message be used in programs offering DMPA-SC self-injection services. However, effective use of the message is contingent upon a consistent supply of DMPA-SC. [ABSTRACT FROM AUTHOR]

Uganda's Obulamu? campaign delivered messages relevant to life stage to address evolving health needs of audiences at times they were likely to change behaviors. We estimated Obulamu?'s effects on HIV/AIDS, family planning, maternal and child health, tuberculosis, malaria, and nutrition behavioral outcomes. We conducted repeated cross-sectional household surveys with women, men, and children's caregivers in 2015 and 2017 in 16 districts using multi-stage probability sampling weighted by population. Eleven pre-specified outcomes were evaluated in multivariable weighted regression models. Survey 1 included 2,377 households with 4,012 individuals and survey 2 included 2,398 households with 3,563 individuals. After controlling for time and potentially confounding factors, we observed notable increases among people exposed to topic-specific messages in condom use with at least one non-marital, non-cohabiting partner in the last six months; recent male circumcision; seeking tuberculosis screening/testing for self; seeking tuberculosis screening/testing for child; delivery of baby in a facility; and caregiver seeking advice or treatment for child under five years with fever. Exposure did not appear to influence knowledge of antiretroviral therapy, delay sexual debut, breastfeeding infants and all of the household's pregnant women/children less than five years sleeping under a net the night before the survey. Exposure to topic-specific messages was associated with improvements in six of the eleven outcomes. Across the health priority areas, we observed improvements in select HIV/AIDS, tuberculosis, and maternal and child health outcomes. We did not observe effects of exposure on select outcomes in the areas of family planning, malaria, or nutrition. [ABSTRACT FROM AUTHOR]