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Ọgụgụ ngwa ngwa Oge Ọgụgụ: 3 nkeji

Azụmahịa emechabeghị maka ịnweta mgbochi afọ na mgbochi HIV

The landmark Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study is the first large-scale randomized clinical trial to investigate the relationship between the use of hormonal family planning methods and the risk of HIV acquisitiona double burden far too many women still face. Although the study’s results have yielded valuable information, our colleagues at FHI 360 explain that there is still plenty of work to do.

Great strides have been made in expanded access to family planning care and HIV prevention services; Otú ọ dị, women continue to suffer the dual burdens of unintended pregnancy and HIV infection. Concerns that contraception itself might increase the risk of HIV acquisition led to the design and implementation of the landmark ECHO trial. ECHO was a randomized clinical trial comparing HIV incidence, adverse events, and pregnancy rates among 7,829 African women randomized to three licensed contraceptive products: intramuscular depot medroxyprogesterone acetate (DMPA), a copper intrauterine device, and a levonorgestrel implant. The results were presented at a conference in Durban, South Africa in June 2019 na published in The Lancet. HIV incidence was similar across the three groups and all methods were safe and highly effective. In light of the ECHO results, the World Health Organization (WHO) convened an expert group to review the data on contraceptive eligibility for women at high risk for HIV acquisition and issued updated guidance in August 2019, which indicated that all trial methods could be safely used by women at high HIV risk.

The ECHO study identified a very high overall HIV incidence of 3.8 per 100 women-years among the young study participants (median age 23 afọ) seeking contraception in the four study countries: Eswatini, Kenya, South Africa, and Zambia. This alarming finding among women who were provided HIV prevention services, including STI screening, condoms, and pre-exposure prophylaxis (PrEP) later in the trial, tempered the encouraging news of no difference in HIV risk by contraceptive method. Discussion of this finding led to calls for urgent and aggressive measures to expand women-centric HIV prevention services, including PrEP, for women in family planning programs. The findings also supported expanded access to the full range of contraceptive products for women at high HIV risk. WHO initiated a concerted effort to support country programs, especially in Africa, to act aggressively on the ECHO findings to enhance FP-HIV integration.

DMPA-IM, 2-rod levonorgestrel implant, and the copper IUD. Photo credit: Leanne Gray
DMPA-IM, 2-mkpara levonorgestrel implant, na IUD ọla kọpa. Foto kredit: Leanne Grey

Ugbu a, n'ime 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, nlekọta, na ọgwụgwọ mmemme. 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. Na mgbakwunye, 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. Ugbu a, 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.

Azụmahịa emechabeghị maka ịnweta mgbochi afọ na mgbochi HIV
Timothy D. Nna-ukwu, MD, DTM&H

Onye isi nchịkwa sayensị, FHI 360

Timothy D. Nna-ukwu, MD, DTM&H bụ Chief Science Officer na FHI 360, Durham, North Carolina. Ọ bụkwa Prọfesọ Adjunct of Epidemiology na Gillings School of Global Public Health, Mahadum North Carolina na Chapel Hill. Ọ na-ahụ maka nyocha na mmemme sayensị nke FHI 360 emere na United States yana site na ụlọ ọrụ FHI 360 na 50 obodo gburugburu ụwa. Dr. Mastro sonyeere FHI 360 n'ime 2008 na-eso 20 afọ n'ọkwa onye isi sayensị na Centlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa US (CDC). Ọrụ ya ekwuwo nyocha na mmemme maka ọgwụgwọ na mgbochi HIV, TB, STIs na ahụike ọmụmụ, gụnyere ije ozi na kọmitii na-ahụ maka sayensị maka ECHO randomized clinical trial na-enyocha ihe ize ndụ ịnweta HIV na uru maka ụzọ mgbochi afọ atọ n'etiti ụmụ nwanyị nọ n'Africa..

Kavita Nanda, MD, MHS

Onye isi nyocha ahụike, Mmepe ngwaahịa na mmeghe, FHI 360

Kavita Nanda, MD, MHS, Onye isi nyocha ahụike, FHI 360, bụ onye dibịa bekee/ọkachamara gynecology bụ onye tinyegoro ọrụ ya n'ịzụlite na imeziwanye ojiji usoro mgbochi afọ maka ụmụ nwanyị.. Ọ bụ onye na-eme nchọpụta na onye isi oche nke kọmitii nchekwa mgbochi mgbochi maka ihe akaebe maka nhọrọ mgbochi afọ ime. (ECHO) ikpe, Nnwale a na-ahụ anya nke multicenter nke ọgwụ mgbochi afọ atọ dị iche iche yana nnweta HIV na 7,800 Ụmụ nwanyị Afrịka nọ n'ihe ize ndụ nke ibute nje HIV. Dr. Nanda rụrụ ọrụ dị ka onye isi nyocha maka ọtụtụ FHI 360 ọmụmụ, gụnyere ikwu maka nchekwa nke ọgwụ mgbochi hormonal n'etiti ụmụ nwanyị nwere ọnọdụ ahụike dị iche iche, na dị ka onye nduzi ahụike ọmụmụ maka ọtụtụ nnukwu nnwale mgbochi HIV. Ugbu a, Dr. Nanda bụ onye isi mmemme iji mepụta ihe ọhụrụ nke nwere ike imebi mkpụrụ ndụ maka mgbochi afọ nke Bill na Melinda Gates Foundation kwadoro..

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