A year after the Evidence for Contraceptive Options and HIV Outcomes study, researchers say policymakers must renew their focus.

The policy brief by the World Health Organisation highlights the need for better HIV & STI (sexually transmitted infections) testing, and action for better clinical and prevention services, particularly among women accessing contraceptives.

“After the results of ECHO came out, we had a long hard think in WHO and together with partners in UNAIDS and WHO, we worked hand-in-hand with our colleagues in the sexual and reproductive health department to think what are the actions that are needed and we produced this policy brief,” says Dr Rachel Beggaley from the WHO.

The document also outlines actions needed to better serve adolescent girls and women who are at high risk of acquiring HIV and STIs, and who need to access contraceptive services.

The recommended approach suggests HIV integration into contraceptive services, where immediate action and immediate on-site integration will take place in areas with an extremely high HIV prevalence rate of more than 20% in adult women.

Prevention and contraception

The report also suggested giving women prevention choices where men are also included. These includes making oral Pre-exposure prophylaxis (PreP) and male and female condoms available. Programmes should encourage male involvement and continue promoting  voluntary medical male circumcision. They should also consider new contraceptive products in the market.

According to Family Planning 2020, the numbers of women and girls that have accessed modern contraceptives as of July 2019 is over 314 million in 69 countries. The ECHO trial found that there was no substantial difference in HIV risk among women using the three methods studied, namely the injectable contraceptive DMPA-IM, the Jadelle implant and the copper IUD. One alarming finding was that HIV infection rates among the study population were alarmingly high: approximately 4%.

“There were lots of discussions on PreP and how we need to get PreP available for young women in high burden settings and we really want to think of ways to do this either to provide within contraceptive services or provide linkages to support to link PreP services,” says Beggaley.

Increased attention on STIs

The WHO is also calling for increased attention on STIs. One concern is that young women infected with STIs are often asymptomatic and the current syndromic approaches may not be adequate. This was particularly prevalent in low to middle-income countries, where women syndromatic treatment misses asymptomatic women. WHO is pushing for better diagnosis and treatment of the infections.

“In the ECHO study it wasn’t only the bad news about the risk of HIV being so significant but also at baseline and during the taking of contraception, both the prevelance and incidence of STIs was very high,” says Beggaley.

Disrupted by Covid-19

Maintaining HIV and contraceptive services has become more crucial with the Covid-19 pandemic disrupting most health services, says Beggaley.

South Africa saw condoms declared non-essential when lockdown restrictions were first introduced. Malaysia, one of five condom manufacturing countries in the world, was not able to produce a single condom for a week due to restrictions.

In some cases, voluntary medical male circumcision and HIV prevention programmes were scaled down or halted to due to the Covid-19 pandemic. Delivering larger supplies over longer periods, or improving access to self-testing could be a solution, the WHO suggests. – Health-e News