Gender

Our 9th Research Digest assembles 87 abstracts published from May through June 2019 that feature evidence from Botswana (6), Eswatini/Swaziland (2), Malawi (12), Mozambique (4), South Africa (46), Tanzania (4), Zambia (7) and Zimbabwe (17).

This analysis offers a wide range of scenarios given the considerable uncertainty over ring uptake, consistency of use, and effectiveness, as well as HIV testing, prevention, and treatment use over the next two decades. This could help inform donors and implementers as they decide where to allocate resources in order to maximize the impact of the dapivirine ring in light of funding and implementation constraints.

ARV-based pre-exposure prophylaxis (PrEP) has the potential to avert many new HIV infections, yet little is known about how to reach women at high risk for HIV infection and motivate them to initiate PrEP. Clinical trials have succeeded in recruiting at-risk participants, evidenced by control arm HIV incidence ≥3% (defined by the World Health Organization as “substantial risk”). We examined experiences from HIV prevention trials to document recruitment strategies and identify practical, potentially effective strategies for reaching women in real-world PrEP delivery.

Results of a pivotal clinical trial among 7,829 women ages 16-35 in East and Southern Africa provide important evidence to help inform women’s choices for contraception and HIV prevention. The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study found no substantial difference in HIV risk among women using the three methods of contraception in the study – the copper-releasing intrauterine device (Cu-IUD), a levonorgestrel (LNG) implant (Jadelle) and depot medroxyprogesterone acetate-intramuscular (DMPA-IM), also known as Depo-Provera.

Injectable, intrauterine, and implantable contraceptives have been prioritised for programmatic delivery because of high contraceptive efficacy and safety. Robust evidence on the relative risks, particularly HIV susceptibility, and benefits of these contraceptive methods is important to inform women's decision making, provider counselling, and policy maker and regulatory decisions. Our primary objective was to compare HIV incidence among women using DMPA-IM, a copper IUD, or a levonorgestrel (LNG) implant.

Reflecting on this year’s South African AIDS Conference, the SHARE team identified six key messages.

At the 9th South African AIDS Conference (SA AIDS 2019), I can only reflect on the work we have done over the years in the fight against HIV. So many inspiring scientists, community representatives and activists in the room working to turn the tide on this virus. ‘Unprecedented innovation and technologies’ was a fitting theme for this year’s biennial conference: 19 years on from the first SA AIDS Conference, South Africa has become a world leader in the work to end AIDS.

Results from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study were released at a session at the 9th South African AIDS Conference (SA AIDS 2019) in Durban, South Africa, on Thursday, June 13th. The session, which included presentations on the primary analysis, was recorded and can be viewed on YouTube here.