The effects, safety and acceptability of compact, pre‐filled, autodisable injection devices when delivered by lay health workers

Objectives To systematically assess (i) the effects and safety and (ii) the acceptability of using lay health workers ( LHW s) to deliver vaccines and medicines to mothers and children through compact pre‐filled autodisable devices ( CPAD s). Methods We searched electronic databases and grey literature. For the systematic review of effects and safety, we sought randomised and non‐randomised controlled trials, controlled before–after studies and interrupted time series studies. For the systematic review of acceptability, we sought qualitative studies. Two researchers independently carried out data extraction, study quality assessment and thematic analysis of the qualitative data. Results No studies met our criteria for the review exploring the effects and safety of using LHW s to deliver CPAD s. For the acceptability review, six qualitative studies assessed the acceptability of using LHW s to deliver hepatitis B vaccine, tetanus toxoid vaccine, gentamicin or oxytocin using Uniject™ devices. All studies took place in low‐ or middle‐income countries and explored the perceptions of community members, LHW s, supervisors, health professionals or programme managers. Most of the studies were of low quality. Recipients generally accepted the intervention. Most health professionals were confident that LHW s could deliver the intervention with sufficient training and supervision, but some had problems delivering supervision. The LHW s perceived Uniject™ as effective and important and were motivated by positive responses from the community. However, some LHW s feared the consequences if harm should come to recipients. Conclusions Evidence of the effects and safety of using CPAD s delivered by LHW s is lacking. Evidence regarding acceptability suggests that this intervention may be acceptable although LHW s may feel vulnerable to blame.