The Contraceptive Action Team (CAT) at the MTN was created in 2012 with essentially one goal in mind: To expand the range of effective contraceptive methods available to women participating in network studies.
The types of contraception offered to participants in MTN trials depended upon the contraceptive methods available within each country. In VOICE – a large trial that MTN conducted in Uganda, South Africa and Zimbabwe between 2009 and 2013 – most women used either the hormonal contraceptive pill or an injectable contraceptive. While women were counseled on other methods, such as contraceptive implants and intrauterine copper devices (IUDs), they were not available directly at the site. Women wanting to use these methods needed to be referred to another facility, which may have been an impediment to their uptake.
It was the experience in VOICE, as well inconclusive information about the potential HIV risk associated with use of the injectable contraceptive DMPA that prompted MTN’s creation of the CAT as it prepared for the launch of another large-scale trial, ASPIRE. The CAT was made up of approximately 40 site staff from the 15 sites in Africa conducting ASPIRE and was guided by a Steering Committee of global family planning researchers, clinicians and advocates.
To achieve the overall goal of expanding the contraceptive mix offered to women enrolled in ASPIRE, the CAT identified a measurable objective: to ensure that each site was able to provide at least four different methods directly onsite. With each site expanding the number of methods available onsite, it was assumed that no single contraceptive method wound represent more than 50 percent of the uptake. Indeed, this had been the case.
Members of the CAT had taken it upon themselves to be their site’s contraceptive experts. They were trained in intrauterine device copper device (IUCD) and implant insertion and continued to integrate comprehensive contraceptive counseling into site activities. As a result, compared to VOICE, fewer women in ASPIRE have opted to use the pill or injectables and many more have decided to use long-acting reversible contraceptives, such as implants or IUCDs.
The CAT met twice a year to share local perspectives, explore misconceptions and identify barriers to the expansion of options, particularly long-acting reversible contraceptive methods.