Women

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.

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.

The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study is an open-label randomised clinical trial comparing three highly effective, reversible methods of contraception — a progestogen-only injectable called depot-medroxyprogesterone acetate (DMPA), a levonorgestrel implant and the non-hormonal copper intrauterine device — to evaluate whether there is any difference in the risk of acquiring HIV infection among users of these methods.Read this fact sheet for more about the ECHO study.

Vaginal dysbiosis and STIs are important drivers of the HIV epidemic and reproductive complications. These conditions remain prevalent, partly because most cases are asymptomatic. We have shown that inflammatory cytokines interleukin (IL)-1alpha, IL-1beta and interferon-gamma-induced protein (IP)-10 are biomarkers for detecting asymptomatic STIs and vaginal dysbiosis (bacterial vaginosis (BV) or intermediate microbiota). This study aimed to validate the performance of these biomarkers in African women recruited regardless of symptoms.

Contraceptive adherence during acute and recent HIV-1 infection is important to maternal and child health given the elevated risk of vertical HIV-1 transmission and additional complications of pregnancy. Injectable contraception (IC) is the most common non-barrier modern contraception method used in sub-Saharan Africa (SSA). Adherence to IC after HIV-1 seroconversion is not well understood.

Past endeavours to deal with the obstacle of expensive Cluster of Difference 4 (CD4(+)) count diagnostics in resource-limited settings have left a long trail of suggested continuous CD4(+) count clinical covariates that turned out to be a potentially important integral part of the human immunodeficiency virus (HIV) treatment process during disease progression. However, an evaluation to determine the strongest candidates among these CD4(+) count covariates has not been well documented.