29 JULY 2016 — More than 18,000 people returned to Durban for the 21st International AIDS Conference (AIDS 2016) last week. The ECHO Study team used this opportunity to engage with stakeholders, provide updates on the trial’s progress and discuss the ECHO Study’s role in the ongoing search for clarity on the risks and benefits of hormonal contraception (HC) for women at risk of HIV.

Highlights included:

One Woman, Many Choices: An interactive learning and strategy session on hormonal contraception and HIV

Advocates, researchers and policy-makers were among the capacity crowd that attended this session at the Research Literacy Zone session in the Global Village, which was convened by AVAC, CHANGE and the International Community of Women Living with HIV Eastern Africa. Sinazo Pato of the Wits Reproductive Health and HIV Institute (RHI) and the ECHO Study provided an update on the study, reporting that in early July, ECHO reached the milestone of enrolling the first 1,000 women. So far study retention is high, and few women have refused their randomly assigned methods. Chelsea Polis of the Guttmacher Institute presented the methodology that she and her colleagues used to conduct an updated systematic review of the data on HC use and HIV acquisition.

Advocates spoke of the importance of clarifying the potential relationship between DMPA use and HIV acquisition so that women at risk of HIV infection can make informed choices about the contraceptives they use. Expressing continued support for the ECHO trial, advocates also emphasised the need to advocate for expansion of the mix of contraceptive methods available to African women while they await more conclusive answers about HC use and the risk of HIV infection.

Global Community Advisory Group Dinner

In addition to the 12 site community advisory boards that advise on the ECHO Study, ECHO also has established a Global Community Advisory Group (GCAG) comprised of 16 advocates and civil society representatives working on HC-HIV and women’s health issues across seven countries in Africa and the US. AIDS 2016 provided the first opportunity for GCAG members to meet in person and have an intimate dinner and discussion with the ECHO Management Committee and other ECHO team members.

Hormonal Contraception and HIV: A review of the science and research and their implications for research, programme and policy

ECHO team members also participated in the satellite session on HC-HIV research organised by the World Health Organization (WHO). This session was jointly chaired by James Kiarie of WHO and Helen Rees of Wits RHI, who are both members of the ECHO Management Committee. Chelsea Polis presented the results of the updated systematic review on HC use and HIV acquisition at this session. She and her colleagues found that additional higher-quality studies of DMPA use are now available, classifying these studies as “informative, with important limitations.” They concluded that with the inclusion of the newer, higher-quality studies, the combined analysis suggests that DMPA use is associated with a 20 percent to 60 percent increase in the risk of HIV acquisition, but they could not rule out study bias because all the data are observational. Polis noted that several new studies that suggest increased risk had few weaknesses except that they were observational. The findings of this study will soon be published and available for in-depth review.

In his presentation on behalf of the ECHO team, Jared Baeten of the University of Washington provided background on the trial, which is being conducted because after more than 25 years of observational and biological studies on HC and HIV, uncertainty remains. He described the ECHO Study design, gave an update on its progress, and outlined the metrics being monitored and the oversight mechanisms in place to ensure that the trial is on track.

Lilian Mworeko of the International Community of Women living with HIV Eastern Africa, and a member of ECHO’s GCAG, spoke eloquently about women’s right to contraceptive choices and the need for clear communication about the risks and benefits of different methods. Advocates were eager to learn more about the implications of the systematic review results for women at risk of HIV infection who are using DMPA or considering its use. The ECHO Study team also will continue to monitor the emerging data and their implications.

Beyond AIDS 2016

As the discussions about hormonal contraceptives and risk of HIV acquisition continue and evolve, one thing remains clear. There is an ongoing need for a randomised trial to provide clear, high-quality evidence that policy makers, providers and family planning clients can use to make informed choices about which contraceptive methods to procure, prescribe and use.

A complete list of sessions and abstracts about HC and HIV can be found on the ECHO website.

ECHO Study @ AIDS 2016: a report from Durban