MEXICO CITY – Women using Depo Provera as a long acting, injectable hormonal contraceptive showed lower rates of sexually transmitted infection that include chlamydia and gonorrhea, during a study undertook with the primary aim of assessing whether the drug raised risks of HIV infection. This is one in several findings released Monday from the Evaluation of Contraceptive Options and HIV Outcomes – or ECHO – trial that cleared the long acting hormonal contraceptive of adding to risks of acquiring HIV.
That primary finding, James Kiarie of the World Health Organization noted, provided family planning programs with the chance to give “a sigh of relief,” over what was otherwise a widely preferred long-acting method of contraception. The other methods tested a copper intrauterine device and levonorgestrel-releasing implant.
Women who chose to use Depo Provera became infected with gonorrhea at a 30% lower rate than women who used the intrauterine device or implant, Jen Deese of FHI 360 said, and also experienced lower rates of chlamydia infection. These results were important in a study that also discovered greatly higher rates of STIs and HIV among study participants than even researchers — who had picked the populations for their high risks of exposure to HIV in communities of high prevalence — had expected.
At the same time the study yielded encouraging findings on the acceptability of pre-exposure prophylactic use of oral antiretroviral drugs — or PrEP — when, halfway through the trial country policies evolved to encourage the HIV infection prevention measure, Ivana Beesham of Witswatersrand University said. The ECHO trial began offering PrEP to participants and a significant proportion of women chose to initiate. Of the two participants who later became infected, one had stopped taking PrEP two months before seroconversion, Beesham said.
“This shows PrEP is feasible as part of the standard of care and should be provided to people as part of a comprehensive HIV prevention package,” she said.
Additionally, findings released later Monday showed few pregnancies occurring with the use of any of the three methods. Rates of pregnancy were higher with the use of the copper IUD, likely because of placement issues.
Study results illustrated urgent needs to better integrate HIV and family planning and sexual and reproductive health services, and offer women a wide range of sexual and reproductive health products to prevent both unwanted pregnancy and HIV and other sexually transmitted infections, Nelly Mugo of the Kenya Medical Research Institute said.
“If a choice is provided, women can choose different methods and use them effectively,” Mugo said.
“What all of these studies show is that we cannot isolate the prevention and treatment of HIV from the rest of people’s lives,” Lucy Stackpool-Moore of the International AIDS Society said. “These issues are not separated in a person’s life and should not be segregated in healthcare systems. Truly integrated, comprehensive care means that a woman should be able to receive effective and quality contraceptive counselling, STI and TB screening and HIV care under one roof.”