Providing clarity about the safety of hormonal contraceptive (HC) methods for women at risk of HIV and for women living with HIV (WLHIV) is a public health priority. The World Health Organization (WHO) publishes the medical eligibility criteria for contraceptive use (MEC). The MEC is an evidencebased guideline informed by a continuous review of evidence that provides recommendations on the safety of contraceptive methods for women with various medical conditions or personal characteristics. These include recommendations for use of different contraceptive methods by women at high risk of HIV, women living with HIV, and women using antiretroviral therapy (ART).
The Evidence for Contraceptive options and HIV Outcomes (ECHO) Trial compares the risks of HIV acquisition between women randomised to intramuscular depo-medroxyprogesterone acetate (DMPA-IM), levonorgestrel (LNG) implant, and copper intrauterine device (IUD). It is expected that ECHO will provide more robust evidence to support and guide individual, policy and programmatic decision-making on contraception for women at risk of HIV acquisition. WHO will incorporate the ECHO results into its review of the relevant MEC recommendations in the context of existing evidence. Given existing patterns of contraceptive use and HIV risk, any new guidance may have implications for country programmes, especially in the sub-Saharan African region. Countries may also need to determine how best to differentiate actions and messages for individuals, populations and locations with distinct patterns of contraceptive use and HIV risk.
Results from this trial are expected in mid-July 2019, after which WHO will review the evidence and, if indicated, revise the MEC.
