Now, in 2021, we are confronted with the additional challenge of the COVID-19 pandemic on access to both family planning care and HIV prevention services. With regard to family planning, important steps to maintain access to critical family planning care for women and girls include using telehealth for counseling, screening, method provision, and side effects management; extended use of IUDs and implants; and self-administration of Sayana Press (DMPA-SC). Unfortunately, many programs have seen drops in attendance and early signs of increased pregnancy rates among young women.
The COVID-19 pandemic has also challenged HIV prevention, care, and treatment programs. In many areas where women are at greatest HIV risk, scale up of PrEP is still at an early stage. Linking PrEP services with family planning offers a “win-win” opportunity. The recent European Medicines Agency endorsement of the dapivirine vaginal ring for HIV prevention for women in high HIV burden settings should lead to a complementary prevention approach in addition to safer sex practices when women cannot take or do not have access to oral PrEP. Additionally, the HIV Prevention Trials Network recently announced that a trial evaluating the safety and efficacy of long-acting injectable cabotegravir (CAB LA) for PrEP in women in Africa was stopped early by the Data and Safety Monitoring Board when CAB LA was found to be superior to oral PrEP in preventing HIV acquisition. The addition of a long-acting injectable PrEP agent to the prevention toolbox should help mitigate access and adherence challenges. Moreover, the 8-week injection schedule can be synchronized to injectable contraceptive provision. Ongoing research will hopefully yield multipurpose technologies that prevent both pregnancy and HIV.
At the completion of the ECHO study, the greatest fear of study investigators was that the world of family planning and HIV prevention would return to business as usual, and not continue to act on the critically important findings for women’s health. Now, with the triple threats of COVID-19, HIV, and unintended pregnancy, we must move decisively to assure that the fear of returning to business as usual, or even business less than usual, is not realized.
To learn more about how to adapt family planning and contraceptive access in the current pandemic context, check out our COVID-19 content.