By Alison Malmqvist, PSI Deputy Director for Family Planning and Reproductive Health & Nina Hasen, PSI Director for HIV & TB Programs
Today the results of the 18-month long ECHO trial were announced. The trial compared HIV incidence across three contraceptives devices: DMPA-IM, the copper IUD and the levonorgestrel implant. The study addressed a long-standing concern that DMPA-IM might be increasing risk for HIV acquisition and was designed to detect a 50% or greater increase in incidence rate in the planned comparisons between methods. Note that the study intentionally did NOT include a “no contraceptive” arm, as its purpose was to provide women with accurate information when choosing a contraceptive method. The data released today shows there no significant difference in HIV incidence between any of the arms, although the number of new infections in the DMPA-IM arm was higher than in either of the others. Thus, the study provides firm evidence that women who use DMPA-IM are not at substantially higher risk for HIV than women using other methods.
However, incidence of HIV, while not linked to contraceptive use, was exceptionally high at 3.81 new infections per 100 person years. It was even higher among women under 26 years of age, at 4.26 infections per 100 person years. These high rates of HIV infection occurred even with regular HIV prevention counseling and condoms offered to every participant as standard practice throughout the trial and the offer of PrEP as it became available.
The trial results are a call to action to think differently about how Consumer-Powered Healthcare can offer women better options for HIV prevention. The high HIV rates among the participants made it clear that we need to better understand women’s perceptions of risk, their desires and how we can create an ecosystem around them to create a healthy life. We need better tools and options to help women understand the risks they face and act on them, whether it be through human-centered design, product development or other means.
More guidance will come as we, as a joint HIV and RH/FP community, unpack how better to consider a woman’s SRHR needs holistically, with her HIV, STI and contraceptive requirements answered together. Links to all public information posted on the WHO website here: https://www.who.int/reproductivehealth/hc-hiv/en/.
‘Reassuring’ contraceptives and HIV trial also a wake-up call, experts say, https://www.devex.com/news/reassuring-contraceptives-and-hiv-trial-also-a-wake-up-call-experts-say-95102
Depo-Provera, an Injectable Contraceptive, Does Not Raise H.I.V. Risk, https://www.nytimes.com/2019/06/13/health/depo-provera-hiv-africa.html
After Echo: ‘Why the study results scare me’, https://bhekisisa.org/article/2019-06-13-00-echo-trial-results-lancet-depro-provera-does-not-increase-hiv-risk-yvette-raphael
#SAAIDS2019: 3 things to know about the ECHO study, https://www.health-e.org.za/2019/06/13/saaids2019-three-things-to-know-about-the-echo-study-results/
Study confirms this popular birth control does not increase your HIV risk, https://bhekisisa.org/article/2019-06-13-00-echo-trial-results-can-depo-cause-hiv-helen-rees-south-africa-birth-control
The Lancet: First randomised trial finds no substantial difference in risk of acquiring HIV for three different forms of contraception, https://www.eurekalert.org/pub_releases/2019-06/tl-pss061119.php
Banner Image: © PSI/Stephanie O’Connor