ECHO Study: No Association Between HIV Infection and Contraceptive Methods

Previous research has suggested a link between use of progestogen-only injectables, particularly DMPA-intramuscular, and increased risk of HIV acquisition for women. However, these studies were unable to determine whether HIV infections were due to the type of contraceptive method used or other factors. But now, investigators of a new study report that there is no link between HIV incidence and contraceptive methods.

“We did not find a substantial difference in HIV risk among the methods evaluated, and all methods were safe and highly effective,” the authors of the study write.

The Evidence for Contraceptive Options and HIV Outcomes (ECHO) study evaluated 3 options for contraceptives: DMPA-intramuscular (DMPA-IM), a 3 monthly, progestogen-only, reversible injectable contraceptive; levonorgestrel implant, a progestogen-only implant inserted under the skin in the upper arm; and a copper-bearing IUD, a device inserted into the uterus. Details of the study were published in The Lancet.

For the study, a total of 7829 sexually active HIV-negative women were enrolled. The participants included women aged 16 to 35 years who wanted to use a modern method of contraception. The participants were randomly assigned to 1 of 3 contraceptive methods and all of the women who participated in the study received ongoing health services including counseling on HIV prevention and care, as well as screening and treatment for STIs.

Results indicate that among the 7829 women who took part in the study, 397 HIV infections occurred; however, there was no statistical difference in the rate of acquisition of HIV among the women. The study authors report that HIV infections were documented in 143 women who used DMPA-IM, 138 women who used a copper-bearing IUD, and 116 in women who used a levonorgesterel implant.

The ECHO study was carried out by a consortium led by FHI 360, University of Washington, Wits Reproductive Health and HIV Institute, and the Human Reproduction Programme at the World Health Organization. The study was carried out in 4 countries with settings of high HIV incidence—Eswatini, Kenya, South Africa, and Zambia.

In addition to the findings on different methods of contraceptives, the study found that incidence of HIV infections among all of the female participants was 3.8% per year on average, which indicates that HIV remains a significant challenge for many women in these countries.

“The rate of HIV infection was higher for women aged less than 25 years irrespective of the method of contraception used,” representatives for the World Health Organization (WHO) said in a press release. “This high rate of HIV infection among women, and especially younger women, reinforces the need to strengthen HIV prevention integration within contraceptive and other sexual and reproductive health services.”

According to the WHO, these services could include HIV testing for women and their partners, linkage to antiretroviral therapy for individuals who test positive for HIV, promotion of condom use, and access to pre-exposure prophylaxis (PrEP).

Further, the incidence of 3.8% is above the WHO suggested threshold for offering PrEP, which, according to the press release, should now be considered in countries where the incidence of HIV is above 3%, as appropriate.

“HIV incidence was high in this population of women seeking pregnancy prevention, emphasizing the need for integration of HIV prevention within contraceptive services for African women. These results support continued and increased access to these three contraceptive methods,” the authors of the report in The Lancet conclude.