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Table 2 Self-administration compared to provider-administered for DMPA-SC to improve contraceptive outcomes

From: Self-administered subcutaneous medroxyprogesterone acetate for improving contraceptive outcomes: a systematic review and meta-analysis

Outcomes$ No. of participants (studies) Certainty of the evidence (GRADE) Relative effect (95% CI) Anticipated absolute effects
Risk with provider-administered Risk difference with self-administration
Continuation: all studies 1261 (3 RCTs) MODERATEa,b RR 1.35 (1.10–1.66) 460 per 1000 161 more per 1000 (46 more to 304 more)
Continuation—LMIC 731 (1 RCT) LOWb,c RR 1.59 (1.40–1.81) 458 per 1000 270 more per 1000 (183 more to 371 more)
Continuation—HIC 530 (2 RCTs) VERY LOWa,b,d RR 1.22 (1.04–1.43) 463 per 1000 102 more per 1000 (19 more to 199 more)
Satisfaction—LMIC 731 (1 RCT) LOWb,c,e RR 1.83 (1.61–2.07) 447 per 1000 371 more per 1000 (273 more to 478 more)
Satisfaction—HIC 398 (1 RCT) VERY LOWa,b,c,e RR 0.95 (0.84–1.07) 730 per 1000 37 fewer per 1000 (117 fewer to 51 more)
Pregnancy 1129 (2 RCTs) VERY LOWa,b,d,f RR 0.47 (0.13–1.67) 12 per 1000 7 fewer per 1000 (11 fewer to 8 more)
Serious adverse events 1261 (3 RCTs) VERY LOWa,b,d,f,g RR 0.34 (0.01–8.22) 2 per 1000 1 fewer per 1000 (2 fewer to 12 more)
Other adverse events 863 (2 RCTs) VERY LOWa,b,d,f,g RR 0.59 (0.28–1.28) 41 per 1000 17 fewer per 1000 (30 fewer to 12 more)
  1. Patient or population: women using DMPA-SC for contraception; Setting: Outpatient; Intervention: Self-administration; Comparison: provider-administered
  2. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
  3. $Outcomes assessed with: Patient reported. Follow up: mean 12 months
  4. CI confidence interval, RR risk ratio
  5. GRADE Working Group grades of evidence: High certainty We are very confident that the true effect lies close to that of the estimate of the effect; Moderate certainty We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; Low certainty Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect; Very low certainty We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
  6. Explanations: aTwo studies had a potential source of selection bias related to the specific study design used: no blinding with a fixed block size
  7. bNeither participants nor study staff were masked due to the nature of interventions. We judge that the performance is likely to be influenced by lack of blinding
  8. cData from one study and optimal information size not fulfilled
  9. dThe number of participants does not reach the optimal information size
  10. eNo blinding of outcome assessor. We judge that the outcome measurement is likely to be influenced by lack of blinding
  11. fWide confidence interval encompassing large effect size and no effect
  12. gData from studies with rare events