ECHO Reverberates Across SRH

by Beth Schlachter, Executive Director, FP2020 @BethFP2020 and Mitchell Warren, Executive Director, AVAC @HIVpxresearch

In July 2019, the HIV and Family Planning (FP) communities will convene around the results of the ECHO (Evidence for Contraceptive Options & HIV Outcomes) trial, which assesses three reversible contraceptives and whether they affect the user’s risk of HIV.

Beth Schlachter, Executive Director of FP2020 joins Mitchell Warren, Executive Director of AVAC, to discuss the trial and the coming together of the HIV and FP communities to work together for women to understand their options.

Q: What is the ECHO trial?

Beth Schlachter: ECHO looks at three highly effective, reversible methods of contraception—the progestogen-only injectable depot medroxyprogesterone acetate (DMPA), a levonorgestrel implant called Jadelle and the copper intrauterine device—to evaluate whether there is any difference in the risk of HIV acquisition among women and girls using these methods. The more evidence and information women and girls have, the better able they are to determine which methods work best for them. Our goal is to ensure they have the information they need to make informed decisions about their healthcare and the study will advance that objective.

Q. Are you worried that one of the contraceptive methods is going to show it increases the risk of acquiring HIV?

Mitchell Warren: No matter the result, the ECHO trial will not provide an answer about what countries, programs or individuals should do; it will provide information that should prompt, inform and guide action by all stakeholders. And as that evidence is used to inform policies and programs, the perspectives and experiences of women and girls who will be affected must be at the center of decisions and messages.

Q. How did FP2020 and AVAC come together to work on ECHO and why?

BS: It was a natural partnership that grew organically. AVAC had been involved with the ECHO trial team for years and FP2020 had been monitoring it. When Mitchell approached us over a

year ago to discuss the need for alignment between the FP and HIV communities, it made so much sense. Working together has enabled us to amplify our individual concerns and bring in many more organizations and advocates to ensure that we use the ECHO trial results as an opportunity to place women and girls at the center of the discussion.

MW: The ECHO trial is a perfect example of what integration and comprehensive sexual and reproductive health really means. This is not about HIV or contraception; this is about putting these pieces together, and no one organization or community can do it alone. Our collaboration with FP2020 shouldn’t be a surprise or an exception. If we want women and girls to have truly informed choice about sexual and reproductive health and rights, contraception and HIV, this has to be the new normal.

Q. Why is the ECHO trial so important to those who care about FP and HIV prevention? What can we learn from it?

MW: Results from the ECHO trial will allow for clearer messages on HIV risk and the three contraceptives studied, and should prompt action. Current data on progestogen-only injectable contraceptives mostly comes from observational studies and are almost entirely focused on injectable DMPA-intramuscular (IM). Some of these studies suggest that DMPA-IM increases their risk of acquiring HIV while others do not. The ECHO trial was designed to address this uncertainty, and is the most rigorously designed and conducted study of contraception and HIV risk in history. Whatever the results are in mid-July, this evidence can and should be used to improve programs that meet the needs of women and girls and support their choices.

Q. Will the HIV and FP communities continue to work together for the foreseeable future?

MW: Even if we collectively and easily navigate the ECHO trial results in the months ahead, I will judge this collaboration—not just between FP2020 and AVAC but comprehensively across our fields—as only partially successful if it stops there. Our great hope is that we are actually building a new infrastructure for advocacy, programs and policies that reflect a new spirit and passion for “integration” that puts women and girls at the center for the long haul.

BS: I couldn’t agree more. Throughout this year, FP2020’s leadership is conducting a global consultation to learn from stakeholders and partners how our current partnership has supported advances for reproductive health services and contraceptive use so the next iteration of this partnership can build on what works for 2030 and beyond. Our collaboration with AVAC shows that the HIV and FP sectors can work effectively together, and the expectation of “integration” must be written into our partnerships going forward. We’re committed to this because women and girls are counting on us to serve their perspectives and needs above our own. We’ve learned so much from AVAC, and it’s been an absolute pleasure to get to know and work in partnership with Mitchell and his dedicated and inspiring team.