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CONTEXT: The copper IUD is safe and effective, but underutilized in Sub-Saharan Africa, in part because of a lack of trained providers. The World Health Organization recommends training mid-level providers--including nurses and midwives--to insert lUDs; however, the safety of such task shifting has not been evaluated in Sub-Saharan Africa. METHODS: Data were drawn from baseline surveys and study charts of 535 sexually active women aged 18-45 who used a copper IUD while participating in an HIV-prevention clinical trial conducted from August 2012 through June 2015 in Malawi, South Africa, Uganda and Zimbabwe. IUDs were inserted by study physicians, nurses and midwives trained as part of the trial, and by local nonstudy providers. Chi-square and Fisher's exact tests were used to compare women's experiences of adverse events--such as irregular bleeding, pelvic pain or device expulsion--by provider type. RESULTS: Half (54%) of women reported experiencing an adverse event; the most common were irregular bleeding and pelvic pain (45% and 25%, respectively). Compared with women who had received an IUD from a study physician or study nurse, greater proportions of women who had received one from a nonstudy provider reported any adverse event (76% vs. 49% and 51%, respectively), irregular bleeding (57% vs. 41% and 45%) and pelvic pain (35% vs. 15% and 32%); the difference between study physicians and nurses was significant only for pelvic pain. Expulsion rates were comparable for study nurses and nonstudy providers (12.3 and 11.9 per 100 woman-years, respectively), but lower for study physicians (7.3 per 100 woman-years). CONCLUSIONS: The findings support task shifting of IUD insertion to mid-level providers to improve IUD access in Sub-Saharan Africa. International Perspectives on Sexual and Reproductive Health, 2019,45:61-69, doi: https://doi.org/10.1363/45e8019 Contexto: Aunque el DIU de cobre es seguro y efectivo, esta subutilizado en Africa subsahariana, en parte debido a la falta de proveedores de servicios de salud capacitados. La Organization Mundial de la Salud recomienda capacitar a los proveedores de nivel medio -incluidas las enfermeras y porteras- para insertar los DIU; sin embargo, la seguridad de tal cambio de tareas ha sido evaluada en Africa subsahariana. Metodos: Se obtuvieron datos de encuestas de llnea de base y cuadros de un estudio de 535 mujeres sexualmente activas, de 18 a 45 anos, que usaron un DIU de cobre en un ensayo cllnico de prevention del VIH realizado entre agosto de 2012 y junio de 2015 en Malaui, Sudafrica, Uganda y Zimbabue. Los DIU fueron insertados por medicos participantes en el estudio, enfermeras y parteras capacitadas como parte del ensayo, asl como por proveedores de servicios de salud locales no relacionados con el estudio. Las pruebas exactas de Chi-cuadrado y Fisher se usaron para comparar las experiencias de las mujeres con eventos adversos -como sangrado irregular, dolor pelvico o expulsion del dispositivo- por tipo de proveedor. Resultados: La mitad (54%) de las mujeres reportaron haber experimentado algun evento adverso; los eventos mas comunes fueron sangrado irregular y dolor pelvico (45% y 25%, respectivamente). En comparacion con las mujeres que hablan recibido un DIU de un medico o de una enfermera del estudio, una gran parte de las mujeres que lo hablan recibido de un proveedor no relacionado con el estudio reportaron algun tipo de evento adverso (76% vs. 49% y 51%, respectivamente), sangrado irregular (57 % vs. 41% y 45%) y dolor pelvico (35% vs. 15% y 32%); La diferencia entre los medicos y las enfermeras del estudio fue significativa solo para el dolor pelvico. Las tasas de expulsion fueron comparables para las enfermeras del estudio y los proveedores no relacionados con el estudio (12.3 y 11.9 por 100 anos-mujer, respectivamente), pero mas bajas para los medicos del estudio (7.3 por 100 anos-mujer). Conclusiones: Los hallazgos respaldan el cambio de tareas de insercion del DIU a proveedores de nivel medio para mejorar el acceso al DIU en Africa Subsahariana. Contexte: Bien qu'il soit sur et efficace, le DIU au cuivre est sous-utilise en Afrique subsaharienne, faute, en partie, de prestataires formes. L'Organisation mondiale de la Sante recommande la formation de prestataires de niveau intermediaire--personnel infirmier et sages-femmes--pour la pose du DIU. La securite de cette delegation de taches n'a cependant pas ete evaluee en Afrique subsaharienne. Methodes: Les donnees proviennent d'enquetes de base et de graphiques d'etude concernant 535 femmes sexuellement actives agees de 18 a 45 ans qui utilisaient un DIU au cuivre dans le cadre d'un essai clinique de prevention du VIH realise d'aout 2012 a juin 2015 en Afrique du Sud, au Malawi, en Ouganda et au Zimbabwe. Les DIU avaient ete poses par les medecins, infirmieres et sages-femmes de l'etude, formes dans le cadre de l'essai, ainsi que par des prestataires locaux exterieurs a l'etude. Le test chi carre et la methode exacte de Fisher ont servi a comparer l'experience d'effets indesirables--tels que saignements irreguliers, douleurs pelviennes ou expulsion du DIU - vecus par les femmes suivant le type de prestataire. Resultats: La moitie (54%) des femmes ont signale un effet indesirable, les plus courants etant les saignements irreguliers et les douleurs pelviennes (45% et 25%, respectivement). Par rapport aux femmes dont le DIU avait ete pose par un medecin ou une infirmiere de l'etude, de plus grandes proportions de celles qui avaient obtenu leur dispositif d'un prestataire exterieur a l'etude ont signale un effet indesirable quelconque (76% contre 49% et 51%, respectivement), des saignements irreguliers (57% contre 41% et 45%) et des douleurs pelviennes (35% contre 15% et 32%). La difference entre les medecins et le personnel infirmier de l'etude n'est significative que pour les douleurs pelviennes. Les taux d'expulsion sont comparables pour les infirmieres de l'etude et les prestataires exterieurs (12,3 et 11,9 pour 100 femmes-annees, respectivement), mais il est moindre pour les medecins de l'etude (7,3 pour 100 femmes-annees). Conclusions: Les resultats sont favorables a la delegation de la pose du DIU aux prestataires de niveau intermediaire pour ameliorer l'acces au DIU en Afrique subsaharienne., The copper IUD is one of the most effective forms of reversible contraception--with an efficacy rate of 99% in the first year of use. (1) It is a long-term method [...]

Background: Clinical trials have found that a monthly dapivirine vaginal ring was well-tolerated and reduced HIV-1 risk among women in sub-Saharan Africa. However, in order for the ring or other novel prevention methods to have optimal impact, it is necessary to understand and address women's challenges to uptake and adherence. This paper provides insight into a few key challenges noted by women using the ring and contraceptives simultaneously.Methods: The qualitative portion of the MTN-020/ASPIRE study consisted of data collection using single in-depth interviews, serial in-depth interviews, and focus group discussions, conducted with 214 participants across 15 sites in Malawi, South Africa, Uganda and Zimbabwe. A coding team used qualitative analysis software to identify themes within the interviews.Results: The primary qualitative themes among participant data pertained to side effects. Participants reported negative side effects related to menses, in some cases attributing these effects to their contraceptives and in others to the vaginal ring. Participants also expressed concern over the long-term impact of contraception and ring use on fertility, including the reversibility of the contraceptive, especially among nulliparous women.Conclusions: Women's attitudes toward contraceptives can impact their willingness to concurrently use and adhere to a novel HIV prevention product. To optimize the potential of both prevention products, researchers should pre-emptively address concerns about contraceptive impact on fertility and counsel women about the expected side effects of contraceptives versus the ring. Clinical trials identifier NCT01617096. Registered on 6-12-2012 at clinicaltrials.gov https://clinicaltrials.gov/ct2/show/NCT01617096. [ABSTRACT FROM AUTHOR]