ECHO trial results released
HIV risk and contraceptive choices
The results of the ECHO (Evidence for Contraceptive Options and HIV Outcomes) trial were presented at the SA AIDS Conference on 13 June 2019.
The study investigated whether the use of the injectable contraceptive medroxyprogesterone acetate, popularly known by the brand name Depo-Provera, was associated with increased risk of HIV compared to other non-barrier methods of contraception.
There is a huge unmet need for contraceptives in Sub Saharan Africa and injectables are the most commonly used method among the minority of girls and women who have access.
The good news is that the injectable, which releases the hormone progestin into the blood to prevent ovulation, is not linked to significantly elevated risk of HIV infection.
However, the bad news is that the ECHO study found that HIV incidence was ‘alarmingly high’ – at 3.81% across the trial sample, despite access to high quality of care.
The report states: “In spite of an individualized HIV prevention package provided to all participants throughout follow-up and country-wide HIV treatment and prevention programmes, HIV incidence was alarmingly high in this population throughout the course of the trial and STI prevalence at baseline was also very high.”
The researchers call for “more aggressive HIV and STI prevention and management efforts for African women, including PrEP and HIV prevention integrated with contraceptive services”.
The findings highlight the need for more intensive, evidence-based efforts to ensure that girls and women have accurate, up-to-date, objective information about the range of contraception choices, their effectiveness, benefits, risks and side effects. If the ability to make an informed choice to to mean anything then the contraceptive options best suited to each individual must be freely and consistently available and accessible.
On 13 June 2019 – more than 30 years after these issues were first raised – initial results of the Evidence for Contraceptive Options & HIV Outcomes study, known as the ECHO study, found no link between the risk of contracting HIV and the use of injectable contraception.