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Time to Tweak Those Training Materials and Service Delivery Guidelines!

A product update for Implanon NXT

This post was authored on behalf of the Implants Access Program Operations Group

Program managers and healthcare providers who offer the one-rod contraceptive implant, Implanon NXT, should be aware of recent updates that affect the product’s administration. This change is in-process around the world, including countries where Implanon NXT is available at the reduced, market access, price.

What’s new?

MSD/Organon1, the manufacturer of Implanon NXT, now recommends a new insertion site for Implanon NXT: inserting the implant over the triceps, still 8-10 cm proximal to the medial epicondyle, but also 3-5 cm posterior to the medial bicipital sulcus. This placement is further towards the back of the arm than previously recommended. During the insertion and removal procedures for Implanon NXT at the new site, the client’s elbow should be flexed and her hand placed under her head.

Why the change?

New research that shows that insertion at this location minimizes risk of injury to nerves, blood vessels, muscles, and other body tissues associated with improper deep insertion.

What does this mean for Implanon NXT Providers?

Trained, experienced Implanon NXT providers, trainers and mentors will need to receive information and appropriate instructions detailing the change in practice to the insertion site (the insertion technique remains otherwise unchanged).

Going forward, all healthcare providers newly being trained in Implanon NXT services should be trained in the new insertion site and technique.

All providers should also be made aware of the former insertion site so that they can appropriately serve clients who received their implant prior to this update and come in for follow-up care and removal.

Family planning curricula for in-service and pre-service training, guidelines and tools, skills assessments, supportive supervision tools, training videos, SOPs, and any other material from which healthcare providers seek guidance on proper administration of the one-rod implant may need to be adjusted to reflect the new site.

Consultation on the Implanon NXT contraceptive implant

How does this change affect clients and services?

Clients should be told of the new insertion site during counseling and prior to insertion, including previous Implanon NXT users who may expect their new implant inserted in the previous location. After the insertion and before applying a pressure bandage, the provider should remind the client where the implant is located and ask her to verify the implant’s presence.

Also, there will be a transition period during which clients with Implanon NXT implants in the old and the new site follow-up with providers for follow-up care or removal. During this period of transition, providers should check both sites to locate the implant. Only when the implant is not palpable in either site should further assessment and imaging be conducted.

What resources are available to support this change?

MSD/Organon has developed support materials with which to update or train providers, shared with Ministries of Health and posted here in multiple languages (English, French, Spanish, Portuguese, and Arabic).

In addition, the Implants Access Program Operations Group has prepared a number of supplementary materials to ease incorporation of the new Implanon NXT guidance into family planning programs. These materials are intended to assist stakeholders in navigating the practical questions that may arise in integrating the new guidance. In particular, a number of tools have been developed and/or updated:

  1. Frequently Asked Questions (FAQs), in English, French, Spanish, and Portuguese
  2. An updated, illustrated job-aid for Implanon NXT insertion, in English, French, Spanish, and Portuguese
  3. An updated, illustrated job-aid for standard implant removal, in English, French, Spanish, and Portuguese
  4. An updated, illustrated job-aid for deep implant removal, in English, French, Spanish, and Portuguese
  5. A guidance document with considerations for updating relevant materials, in English, French, Spanish, and Portuguese
  6. Updated Implants Module of the Training Resource Package (TRP) for Family Planning

We encourage readers to share this blog and the linked materials with relevant colleagues! And, should any questions arise, kindly channel them to implants.quality@jhpiego.org.

About the authors

This work is co-authored by members of the Implants Access Program Operations Group—a working group comprised of representatives from the Bill & Melinda Gates Foundation, the United States Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the World Health Organization, and Jhpiego.

1 In early 2020, MSD (Merck & Co., Inc. in the US and Canada) announced a spinoff company, Organon, under which women’s health products would fall. As this transition is underway (through mid-2021), you may find the names Organon, MSD and Merck & Co., Inc. used interchangeably. More information here.

Implanon NXT contraceptive implant
Megan Christofield

Technical Advisor, Jhpiego, Jhpiego

Megan Christofield is a Technical Advisor at Jhpiego, where she provides family planning technical assistance and serves as a global technical lead for self-care. Megan specializes in supporting teams through product introduction and scale-up, use of systematic advocacy approaches, and application of design thinking. She’s a recognized thought leader in the movement towards universal access to contraception, published in the journal of Global Health Science & Practice, STAT, and interviewed in WIRED.

Ricky Lu

Jhpiego

Dr. Ricky Lu is Director of Family Planning and Reproductive Health at Jhpiego, where he has supported over 30 countries on three continents in the last two decades. He has experience in expanding access to high-quality family planning services, supporting cervical cancer prevention in low-resource settings, integrating breast health, and maternal and newborn care. Dr. Lu leads Jhpiego’s efforts to advocate for and implement evidence-based approaches to post-pregnancy family planning, client-centered or enabled self-care, and smart technologies to improve provider performance and client engagement.

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