The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study

More than 150 million women worldwide use modern methods of contraception for family planning. These contraceptive methods have been safely employed for decades.

As the HIV epidemic spread, it became important to explore risk factors for HIV and particularly whether there was an association between use of specific contraceptives and HIV acquisition. A number of observational studies — studies in which women chose their own contraceptive method — have examined whether or not use of hormonal methods affects the risk of HIV acquisition. Some of these studies suggest that injectable methods — particularly depo-medroxyprogesterone acetate (DMPA) — might increase a woman’s risk of acquiring HIV infection, while other studies show no association. The World Health Organization continuously reviews the information about contraceptives and, thus far, has determined that all of the contraceptives that will be used in the ECHO Study are safe for women at risk of HIV risk infection, but that more research is needed. Except for condoms, no contraceptive method protects against HIV or other sexually transmitted infections, and thus women at risk of HIV infection who are using contraception should also be advised to use condoms.

The lack of definitive data from observational studies makes it difficult to offer guidance on contraceptive use in settings where women have a high risk of acquiring HIV and where many women use progestin-only injectable methods such as DMPA, often due to limited options for contraception.

Women need to know about any risks associated with contraceptive use so they can make informed choices. They also need to know if there is or is not a true association between these methods and HIV acquisition. Otherwise, they might avoid the use of injectables or other contraceptive methods unnecessarily, risking unintended pregnancies that pose a high risk of maternal death and morbidity.

The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study is designed to fill this critical knowledge gap. The ECHO Study is an open-label randomised clinical trial that will compare three highly effective, reversible methods of contraception (including a non-hormonal method) to evaluate whether there is a link between use of any of these methods and increased risk of acquiring HIV infection. The trial also provides an opportunity to compare pregnancy rates and contraceptive method switching across the study contraceptives. A randomised clinical trial among about 7,800 women in four countries, ECHO will deliver evidence to support and guide individual, policy and programmatic decisions on contraception for women at risk of acquiring HIV infection.

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