Uptake and early removals of Implanon NXT in South Africa: Perceptions and attitudes of healthcare workers
Background. The South African (SA) government introduced Implanon NXT, a long-acting subdermal contraceptive implant, in 2014 to expand contraceptive choice. Following an initial high uptake, its use declined considerably amid reports of early removals and frequent side-effects. We examine providers’ perceptions of training and attitudes towards Implanon NXT, as well as their views on the causes of early removals and the impact on the implant service.

Objective. To assess healthcare providers’ perceptions and attitudes towards implant services in SA.

Methods. In-depth interviews were conducted with eight nurses providing implant services in public facilities in Gauteng and North West Province. Emerging themes were identified, manually coded and thematically analysed following an interpretivism approach.

Results. Nurses lacked confidence in providing implant services effectively, particularly removals, which they ascribed to the brief, cascade-type training received. Nurses generally held negative views towards the method. They also reported that side-effects are the most common reason for early removals – particularly irregular bleeding – and that men often do not support their partners who use the method. Lastly, it was found that providers require guidance on counselling regarding the method and standardised guidelines on the management of side-effects.

Conclusion. Retraining and support of providers are needed to address competency gaps and negative attitudes towards the method. Assessment of providers’ readiness to perform removal procedures is also important. Finally, effective plans are necessary to improve implant continuation rates, especially among women whose partners are unsupportive.
['Adeagbo|O|O|', 'Mullick|S|S|', 'Pillay|D|D|', 'Chersich|M|M|', 'Morroni|C|C|', 'Naidoo|N|N|', 'Pleaner|M|M|', 'Rees|H|H|']
D000328:Adult D000568:Amenorrhea D001291:Attitude of Health Personnel D003267:Contraception D020878:Device Removal D005260:Female D006282:Health Personnel D006801:Humans D007434:Intrauterine Devices D008297:Male D013019:South Africa D055815:Young Adult
Implanon NXT South Africa Contraception Providers' training and perceptions subdermal implant