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ECHO study finds high rates of HIV and STIs among women in trial countries

Written by: Administrator
Monday, July 22nd, 2019, 7:03

Experts have unearthed new evidence presented at the 10th IAS Conference on HIV Science (IAS 2019) today in Mexico city, Mexico which offers further analysis from the highly-publicized Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial, which just a few weeks ago finally put to rest the long-standing concern that certain hormonal contraceptives might increase women’s risk of becoming infected with HIV.

ECHO was a randomized, open-label clinical trial conducted in four African countries that compared HIV risk among women on the three most commonly used methods of hormonal contraception: the DMPA-IM shot, a copper intrauterine device (IUD) and a levonorgestrel (LNG) implant.

The trial found that HIV risk does not differ significantly by contraceptive method. But it also found high rates of HIV incidence overall among young women in the trial countries: eSwatini, Kenya, South Africa and Zambia.

A press conference at IAS 2019 featured three abstracts from the ECHO trial.

“What all of these studies show is that we cannot isolate the prevention and treatment of HIV from the rest of people’s lives,” Lucy Stackpool-Moore, International AIDS Society Director of HIV Programmes and Advocacy, said. “These issues are not separated in a person’s life and should not be segregated in healthcare systems. Truly integrated, comprehensive care means that a woman should be able to receive effective and quality contraceptive counselling, STI and TB screening and HIV care under one roof.”

The first study looks at the very high incidence of HIV among women and girls in South Africa, a country that has invested in scale up of HIV testing, antiretroviral therapy and pre-exposure prophylaxis (PrEP). The ECHO trial included sexually active, HIV-negative women aged 16-35 years, seeking effective contraceptives and willing to be randomly assigned one of the three hormonal contraceptive methods.


Women were followed for 12-18 months across nine sites in South Africa, plus three in Kenya, the Kingdom of eSwatini and Zambia. A total of 345 HIV infections occurred during the trial period, for an incidence of 4.51 per 100 woman-years of follow up. Incidence was higher than 3.30 per 100 woman-years at all South African sites; at one site, it reached 6.80 per 100 woman-years.


Absract: High HIV incidence among young women in South Africa: data from the ECHO trial

The second abstract compares risk of sexually transmitted infections (STIs) among women using different methods of hormonal contraception. The authors measured a baseline of 4.7% STI prevalence for Neisseria gonorrhoeae (NG) and 18.2% for Chlamydia trachomatis (CT), with comparable prevalence by randomized arm and higher prevalence among women aged 24 years and younger versus those older than 24. Despite treatment during follow-up visits, STI prevalence at the final visit was 4.8% for NG and 15.4% for CT.

Abstract: Risk of sexually transmitted infections among women randomized to DMPA-IM, the copper IUD, and levonorgestrel implant in the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial

The third abstract shares insights on PrEP uptake among women who participated in the ECHO trial. The authors found that integrating PrEP into a larger intervention was feasible and that a significant proportion of women elected to use PrEP when the choice was made available to them. During the course of the trial, national policies and guidelines in the study countries evolved to recommend PrEP for people at risk of HIV, and the trial team prioritized access to PrEP for participants. PrEP access in ECHO began in Kenya in May 2017 and was available at all sites by June 2018. Of the 3,626 women (46.3% of trial total) in follow up when PrEP became available, 622 (17.2%) initiated PrEP.

Abstract: Integrating oral PrEP delivery into a large HIV endpoint-driven clinical trial in Eastern and Southern Africa: the ECHO trial experience

Additionally, the press conference included a study that looked at survival for people living with HIV – with and without TB co-infection – in Latin America from 2006 to 2015. The study found that among 19,000 people living with HIV in Latin America, mortality rates were higher in people who were also living with TB, although survival increased over time regardless of TB status. This research provides big-picture findings from an under-researched region of the world.


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