Integrated Family Planning and HIV Services for Youth: Applying ECHO Study Findings in the COVID-19 Pandemic

Just over one year ago, the results of the Evidence for Contraceptive Options and HIV Outcomes Study (ECHO) study were released. ECHO was conducted to address years of concern that people who use the contraceptive depot medroxyprogesterone acetate (DMPA) might be at increased risk of HIV infection.

The study found that are that there was no substantial difference in HIV risk among women using the three contraceptive methods studied. All methods (listed below) were safe, highly effective, and acceptable to the study participants. The study also found that although study participants received high quality counseling and clinical contraceptive and HIV services, HIV and sexually transmitted infection (STI) acquisition remained alarmingly high. Here’s the full ECHO Study.

The study evaluated women and adolescent girls’ likelihood of acquiring HIV while using one of three contraceptive methods (see below), over a period of 18 months. The study compared the rate of HIV infection among 7,800 sexually active HIV-negative women between the ages of 16 and 35 in eSwatini, Kenya, South Africa, and Zambia, who wanted to prevent a pregnancy and volunteered to be randomly assigned to use one of the following contraceptive methods:

  • The intramuscular injectable (also known as Depo Provera or DMPA);
  • The copper IUCD (or intrauterine contraceptive device); or
  • The levonorgestrel implant (also known as Jadelle)

The study confirmed all three methods are safe and effective in preventing unintended pregnancies. Women who used any one of the three contraceptive methods studied had very low rates of unintended pregnancies, and there was no substantial difference in risk of HIV among users of the three contraceptive methods studied.

However, it was discouraging to learn that after decades of efforts to lower the rates of HIV and STIs through a combination of behavior change, structural change, and biomedical approaches (i.e. the provision of counseling, HIV testing, condoms, and STI case management), HIV and STI rates are still unacceptably high.

Since the study findings were released in 2019, COVID-19 has changed everything. Nevertheless, the findings from the study remain relevant and useful, especially as countries consider ways for more effective and efficient use of limited resources that must address multiple health challenges.