Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa

Smith, Jennifer A, Beacroft, Leo, Abdullah, Fareed, Buthelezi, Buyile, Makua, Manala, Morroni, Chelsea ORCID: https://orcid.org/0000-0002-2026-6039, Ramjee, Gita, Velasquez, Claudia and Hallett, Timothy B (2020) 'Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa'. Journal of the International AIDS Society, Vol 23, Issue 10, :e25620.

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Abstract

Introduction: Some observational data suggest that the progestogen injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase a woman’s risk of HIV acquisition but a randomized clinical trial did not find a statistically significant increase in HIV risk for women using DMPA compared to two other methods. However, it could not rule out up to 30% increased HIV risk for DMPA users. We evaluate changes to contraceptive method mix in South Africa under different assumptions about the existence and strength of a possible undetected relationship between DMPA use and HIV risk.
Methods: A mathematical model was developed to simulate the ongoing HIV epidemic and contraceptive method mix in SouthAfrica to estimate how changes in method mix could impact HIV- and reproductive health-related outcomes. We made different assumptions about the relationship between DMPA use and HIV risk, from no relationship to a 30% increase in HIV risk for women using DMPA. Scenario analyses were used to investigate the impact of switching away from DMPA predominance to new patterns of contraceptive use.
Results: In South Africa, the HIV-related benefits of reduced DMPA use could be as great as the harms of increased adverse reproductive health outcomes over 20 years, if DMPA did increase the risk of HIV acquisition by a relative hazard of infectionof 1.1 or greater. A reduction in DMPA use among HIV-positive women would have no benefit in terms of HIV infections, butwould incur additional negative reproductive health outcomes. The most important driver of adverse reproductive health out-comes is the proportion of women who switch away from DMPA to no contraceptive method.
Conclusions: If there is any real increased HIV risk for DMPA users that has not been detected by the recent randomized trial, a reduction in DMPA use could reduce the ongoing number of new HIV infections. However, such a change would place more women at risk of adverse reproductive health effects. It is imperative that these effects are minimized by focusing on expanding access to safe, effective and acceptable alternative contraceptive methods for all women.

Item Type:	Article
Uncontrolled Keywords:	HIV; hormonal contraception; theoretical models; pregnancy complications; women; South Africa
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WP Gynecology > Contraception > WP 630 Contraception
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1002/jia2.25620
Depositing User:	Tina Bowers
Date Deposited:	06 Nov 2020 14:30
Last Modified:	06 Nov 2020 14:30
URI:	https://archive.lstmed.ac.uk/id/eprint/16013

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