Alison B Comfort1, Slavea Chankova2, Randall Juras3, C Natasha Hsi4, Lauren A Peterson5, Payal Hathi6. 1. Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, United States. Electronic address: Alison_Comfort@abtassoc.com. 2. Abt Associates, 4550 Montgomery Avenue, Bethesda, MD 20814, United States. Electronic address: slavea_chankova@abtassoc.com. 3. Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, United States. Electronic address: Randall_Juras@abtassoc.com. 4. Abt Associates, 4550 Montgomery Avenue, Bethesda, MD 20814, United States. Electronic address: nhsi@dexisonline.com. 5. Abt Associates, 4550 Montgomery Avenue, Bethesda, MD 20814, United States. Electronic address: Lauren_Peterson@abtassoc.com. 6. Abt Associates, 55 Wheeler Street, Cambridge, MA 02138, United States. Electronic address: payal.hathi@gmail.com.
Abstract
OBJECTIVES: To improve access to contraceptives in remote and rural areas, sub-Saharan African countries are allowing community health workers (CHWs) to distribute hormonal contraceptives. Before offering hormonal contraceptives, CHWs must determine pregnancy status but often lack a reliable way to do so. No studies have evaluated the impact of providing CHWs with urine pregnancy test kits. We assessed the impact of giving CHWs free pregnancy test kits on the number of new clients purchasing hormonal contraceptives from CHWs. STUDY DESIGN: We implemented a randomized experiment in Eastern Madagascar among CHWs who sell injectable and oral hormonal contraceptives. A total of 622 CHWs were stratified by region and randomly assigned at the individual level. Treatment-group CHWs were given free pregnancy tests to distribute (n analyzed=272) and control-group CHWs did not receive the tests (n analyzed=263). We estimated an ordinary least-squares regression model, with the monthly number of new hormonal contraceptive clients per CHW as our primary outcome. RESULTS: We find that providing CHWs with free pregnancy test kits increases the number of new hormonal contraceptive clients. Treatment-group CHWs provide hormonal contraceptives to 3.1 new clients per month, compared to 2.5 in the control group. This difference of 0.7 clients per month (95% confidence interval 0.13-1.18; p=.014) represents a 26% increase. CONCLUSIONS: Giving CHWs free pregnancy tests is an effective way to increase distribution of hormonal contraceptives. As pregnancy tests become increasingly affordable for health-care systems in developing countries, community-based distribution programs should consider including the tests as a low-cost addition to CHWs' services. IMPLICATIONS: No study has evaluated the impact of giving CHWs free urine pregnancy test kits for distribution to improve provision of hormonal contraceptives. Giving CHWs free pregnancy test kits significantly increases the number of clients to whom they sell hormonal contraceptives. Community-based distribution programs should consider including these tests among CHWs' services.
RCT Entities:
OBJECTIVES: To improve access to contraceptives in remote and rural areas, sub-Saharan African countries are allowing community health workers (CHWs) to distribute hormonal contraceptives. Before offering hormonal contraceptives, CHWs must determine pregnancy status but often lack a reliable way to do so. No studies have evaluated the impact of providing CHWs with urine pregnancy test kits. We assessed the impact of giving CHWs free pregnancy test kits on the number of new clients purchasing hormonal contraceptives from CHWs. STUDY DESIGN: We implemented a randomized experiment in Eastern Madagascar among CHWs who sell injectable and oral hormonal contraceptives. A total of 622 CHWs were stratified by region and randomly assigned at the individual level. Treatment-group CHWs were given free pregnancy tests to distribute (n analyzed=272) and control-group CHWs did not receive the tests (n analyzed=263). We estimated an ordinary least-squares regression model, with the monthly number of new hormonal contraceptive clients per CHW as our primary outcome. RESULTS: We find that providing CHWs with free pregnancy test kits increases the number of new hormonal contraceptive clients. Treatment-group CHWs provide hormonal contraceptives to 3.1 new clients per month, compared to 2.5 in the control group. This difference of 0.7 clients per month (95% confidence interval 0.13-1.18; p=.014) represents a 26% increase. CONCLUSIONS: Giving CHWs free pregnancy tests is an effective way to increase distribution of hormonal contraceptives. As pregnancy tests become increasingly affordable for health-care systems in developing countries, community-based distribution programs should consider including the tests as a low-cost addition to CHWs' services. IMPLICATIONS: No study has evaluated the impact of giving CHWs free urine pregnancy test kits for distribution to improve provision of hormonal contraceptives. Giving CHWs free pregnancy test kits significantly increases the number of clients to whom they sell hormonal contraceptives. Community-based distribution programs should consider including these tests among CHWs' services.
Authors: Alison B Comfort; Cynthia C Harper; Alexander C Tsai; James Moody; Jessica M Perkins; Justin Ranjalahy Rasolofomana; Cora Alperin; Anja Noeliarivelo Ranjalahy; Ravo Heriniaina; Paul J Krezanoski Journal: Contraception Date: 2021-04-24 Impact factor: 3.375
Authors: Anne Gatuguta; Barbra Katusiime; Janet Seeley; Manuela Colombini; Isaac Mwanzo; Karen Devries Journal: BMC Int Health Hum Rights Date: 2017-10-12