DEPO PROVERA SAFE

Popular contraceptives cleared of HIV link

The ECHO Study began in December 2015, enrolling and following 7,829 sexually active, HIV-negative women ages 16 to 35 years

In Summary

‏• Evidence from observational studies conducted over 30 years had suggested the use of Depo increases women’s risk of HIV acquisition by 40 to 50 per cent.

• But the 397 HIV infections the occurred during the three-year ECHO study were evenly spread out among the three birth control methods used for trial. 

A medic explains to a woman different contraception methods.
A medic explains to a woman different contraception methods.
Image: Jhpiego/Kate Holt

Commonly used contraceptive Depo Provera has been declared safe after scientists invalidated 30-years-long claims that it increases the risk of HIV infection.

A clinical trial found no substantial difference in HIV risk among 7,829 African women who were randomly assigned to use Depo and two other birth control methods. 

The results were announced yesterday in South Africa after three years of study.

 

In Kenya, 900 women in Kisumu took part in the study, locally coordinated by the Kenya Medical Research Institute. Other women were from Eswatini, South Africa and Zambia.

Depo Provera is popular in Kenya, where it is used by about two million women and is injected into the arm every three months.

Evidence from observational studies conducted over 30 years had suggested that the use of hormonal contraception, particularly Depo, may increase women’s risk of HIV acquisition by 40 to 50 per cent.

“But uncertainty remained because the available data were subject to the biases associated with observational studies. Few studies had examined whether hormonal implants or IUDs affected users’ risk of HIV acquisition,” Nelly Mugo, head of the sexual, reproductive, adolescent and child health research programme at Kemri said.

She spoke yesterday during the presentation of the results from the study, named the Evidence for Contraceptive Options and HIV Outcomes (ECHO).

Researchers compared the risk of HIV acquisition among women randomised to Depo provera (also known as DMPA-IM), a non-hormonal copper intrauterine device (copper IUD) and a progestin-based implant known as LNG implant.

“Tens of millions of women rely on DMPA-IM, which is often the only modern method of contraception available in local family planning clinics,” Mugo said.

 

The trial did not find a substantial difference in HIV risk among the methods evaluated because no method showed a 50 per cent increase in HIV risk compared to the other two.

Of the 397 HIV infections that occurred, 143 were among women in the Depo group, 138 were in the copper IUD group and 116 were in the LNG implant group.

HIV incidence per year by group was 4.19 per cent for Depo, 3.94 per cent for Copper IUD and 3.31 per cent for LNG implant.

“The results of this study are reassuring, but our findings are also sobering because they confirm unacceptably high HIV incidence among young African women irrespective of which contraceptive method they were assigned to,”   Helen Rees from the University of Witwatersrand in Johannesburg said.

The trial was funded by the Bill & Melinda Gates Foundation, Usaid, Pepfar, the Swedish International Development Cooperation Agency, the EU, the South African Medical Research Council and the UNFPA.

The outcome has also been published in The Lancet journal.

“The study also highlights the need to step up HIV prevention efforts in these high-burden countries, particularly for young women,” James Kiarie of the department of reproductive health and research at the WHO said.

The ECHO Study began in December 2015, enrolling and following 7,829 sexually active, HIV-negative women ages 16 to 35 years across 12 clinical trial sites in the four countries.

The participants were recruited for no risk factors other than living in an area with high HIV prevalence.

They received individualised counselling, condoms and other HIV prevention services during every study visit.

ECHO did not include a control group, because it would have been unethical to give participants who were seeking effective contraceptive a placebo or no method.