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SEATTLE – There is no substantial difference in HIV risk between three highly effective methods of contraception, as shown by the results of a randomized clinical trial conducted in four African countries. But the results reveal high rates of HIV contracted among each group of women studied, which calls for further integration of HIV prevention into family planning services.
The results of the Evidence for Contraceptive Options and HIV Outcomes study, or ECHO, conducted from December 2015 to October 2018, were announced today at the South African AIDS Conference in Durban.
"We are very rebadured by the results. But it is a call to alert that should lead us to do much more in family planning services for HIV treatment and prevention. "
– Rachel Baggaley, HIV Screening and Prevention Coordinator at WHO
The ECHO study, led by a consortium led by FHI 360, the University of Washington, the Wits Reproductive Health and HIV Institute and the World Health Organization, compared the risk of acquiring HIV among 7,829 women on 12 sites in Eswatini, Kenya, South Africa. and in Zambia. Women, aged 16 to 35 and HIV-negative at the start of the trial, were randomized to use one of the following three methods of contraception: injecting medroxyprogesterone acetate-depot progestin alone, or DMPA-IM; a non-hormonal copper intrauterine device, or IUD; and a progestin-based implant containing the hormone levonorgestrel or LNG.
The study aimed to determine the risks and comparative advantages of three contraceptive options, none of which posed a higher risk of HIV infection. ECHO found that of 717 out of 827 HIV-infected women, 143 belonged to the DMPA-IM group, 138 to the copper IUD group and 116 to the LNG group.
Rebaduring – and sobering
The study comes after decades of uncertainty surrounding the relationship between several types of contraceptives and the increased risk of HIV.
"Many of us have been pursuing this issue for a long time, trying to get an answer," FHI 360 Scientific Officer Timothy Mastro told a press conference prior to the release of the report.
Observational studies conducted over the last 30 years have shown that the use of hormonal contraception – particularly DMPA-IM, widely used in countries with high HIV rates among women – could increase by 40 to 50% risk of HIV infection. Helen Rees, executive director of Wits RHI, told the information meeting that these data are subject to biases badociated with observational studies.
The family planning community was concerned that, according to the findings of the study, governments or health care providers are not panicking and limiting access to any extremely effective contraceptive method. The findings of the ECHO trial have rebadured and rebadured the sector and the entire global health community, members of the ECHO consortium said at a press conference.
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Continued strong use throughout the contraceptive study not available in these settings, such as progestin-based implant and copper IUD, shows that increased and improved family planning options would benefit women , noted Fastro 360, Mastro.
"We hope that the results of ECHO will be used to expand and not restrict women's contraceptive options," said Mastro.
Nevertheless, despite the fact that women received individualized counseling, condoms and other HIV prevention services at each study visit, the findings also highlight an "unacceptable incidence of HIV among African young women, regardless of the contraceptive method to which they were badigned, "Wits RHI's Rees said.
Rachel Baggaley, WHO's coordinator for HIV testing and prevention, said the 397 total HIV infections, or 3.81% per year, should be used "to strengthen HIV services in the world." framework of family planning ".
There is an urgent need to intensify HIV prevention efforts in hard-hit countries, especially among young women, Baggaley said. And the environments in which family planning is already available provide an ideal opportunity for women not only to choose a method of contraception, but also to be tested for HIV and to benefit from a range of prevention services, including: she explained.
"We are very rebadured by the results. But this is a wake up call that we should be doing a lot more in family planning services for HIV treatment and prevention, "said Baggaley. "We need to get a lot more information in communities about [pre-exposure prophylaxis]Said Baggaley. "PrEP is not really understood and known in communities."
In the meantime, WHO will immediately begin to synthesize the evidence and share the results with its guideline development group, which will meet at the end of July 2019.
This group will review the results of the ECHO trial as well as other recent research to determine if there is a need to change global guidelines on contraceptive use, said James Kiarie of the Department of Reproductive Health and Reproductive Health. the research. The recommendations will be issued by the end of August 2019.
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