Task sharing is a strategy with potential to increase access to effective modern contraceptive methods. This study examines whether community health extension workers (CHEWs) can insert contraceptive implants to the same safety and quality standards as nurse/midwives. We analyze data from 7,691 clients of CHEWs and nurse/midwives who participated in a noninferiority study conducted in Kaduna and Ondo States, Nigeria. Adverse events (AEs) following implant insertions were compared. On the day of insertion AEs were similar among CHEW and nurse/midwife clients—0.5 percent and 0.4 percent, adjusted odds ratio (aOR) 0.92 (95 percent CI 0.38–2.23)—but noninferiority could not be established. At follow-up 6.6 percent of CHEW clients and 2.1 percent of nurse/midwife clients experienced AEs. There was strong evidence of effect modification by State. In the final adjusted model, odds of AEs for CHEW clients in Kaduna was 3.34 (95 percent CI 1.53–7.33) compared to nurse/midwife clients, and 0.72 (95 percent CI 0.19–2.72]) in Ondo. Noninferiority could not be established in either State. Implant expulsions were higher among CHEW clients (142/2987) compared to nurse/midwives (40/3517). Results show the feasibility of training CHEWs to deliver implants in remote rural settings but attention must be given to provider selection, training, supervision, and follow-up to ensure safety and quality of provision.

中文翻译：

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尼日利亚两个州社区健康推广工作者与护士和助产士提供避孕植入物的安全性、质量和可接受性

任务共享是一种策略，有可能增加获得有效现代避孕方法的机会。本研究检验社区健康推广工作者 (CHEW) 是否可以按照与护士/助产士相同的安全和质量标准植入避孕药具。我们分析了参与在尼日利亚卡杜纳州和翁多州进行的非劣效性研究的 7,691 名 CHEW 客户和护士/助产士的数据。比较了植入物插入后的不良事件 (AE)。在 CHEW 和护士/助产士客户中，插入当天的 AE 相似——0.5% 和 0.4%，调整优势比 (aOR) 0.92 (95% CI 0.38-2.23)——但无法确定非劣效性。在随访中，6.6% 的 CHEW 客户和 2.1% 的护士/助产士客户经历了 AE。有强有力的证据表明国家修改了效果。在最终调整后的模型中，与护士/助产士客户相比，Kaduna CHEW 客户的 AE 几率为 3.34（95% CI 1.53–7.33），Ondo 为 0.72（95% CI 0.19–2.72]）。任何一个国家都无法确立非劣效性。与护士/助产士 (40/3517) 相比，CHEW 客户 (142/2987) 的植入物排出率更高。结果表明，培训 CHEW 在偏远农村地区提供植入物的可行性，但必须注意提供者的选择、培训、监督和跟进，以确保提供的安全和质量。与护士/助产士 (40/3517) 相比，CHEW 客户 (142/2987) 的植入物排出率更高。结果表明，培训 CHEW 在偏远农村地区提供植入物的可行性，但必须注意提供者的选择、培训、监督和跟进，以确保提供的安全和质量。与护士/助产士 (40/3517) 相比，CHEW 客户 (142/2987) 的植入物排出率更高。结果表明，培训 CHEW 在偏远农村地区提供植入物的可行性，但必须注意提供者的选择、培训、监督和跟进，以确保提供的安全和质量。