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

More than 150 million women worldwide use modern methods of contraception for family planning. By enabling women to avoid high-risk pregnancies, these contraceptive methods help prevent hundreds of thousands of maternal and infant deaths every year.

As the HIV epidemic spread, it became important to explore risk factors for HIV, including whether there was an association between use of specific contraceptives and HIV acquisition. There is evidence from observational studies that use of progestogen-only injectable methods — particularly depo-medroxyprogesterone acetate (DMPA) — is associated with an increased risk of acquiring HIV infection, but uncertainty remains about whether DMPA use actually causes increased risk.

The World Health Organization has determined that women at high risk of HIV infection may use DMPA because the benefits outweigh the possible risks, but that more research is needed. Data on whether use of contraceptive implants or IUDs affects HIV risk are also limited. 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. Read more

ECHO study timeline

Completion of the exit visits marked the end of the data collection phase of the ECHO Study and the beginning of data verification, which involves reviewing all the data—collected from 7,830 women over three years—to make sure that they have been recorded correctly and consistently. Once the data have been verified, the ECHO research team will analyse them, following a detailed statistical analysis plan that is part of the study protocol. The study results are expected in mid-2019.

Webinar: Supporting Countries to Plan for ECHO Trial Results, May 2019
Webinar: Preparing for the ECHO Trial Results - WHO Perspectives, Apr 2019
Webinar: Hormonal Contraception and HIV Risk: Understanding the ECHO Trial, Apr 2019
Pharmacokinetic, biologic and epidemiologic differences in MPA- and NET-based...
Rationale and design of a multi-center, open-label, randomised clinical trial comparing HIV...
Dapivirine vaginal ring use does not diminish the effectiveness of hormonal contraception.
ECHO Update Dec 2018
ECHO Update May 2018
ECHO Update Dec 2017

Useful resources

Updated: ECHO Study Q&A, April 2019
Results for Informed Choice Website
WHO/HRP's Web-page on the ECHO Study