ECHO study finds high rates of HIV and STIs among young women in 4 African countries

Henry Opondo

New evidence from eSwatini, Kenya, South Africa and Zambia presented at the 10th IAS Conference on HIV Science (IAS 2019) in Mexico show high rates of HIV incidence overall among young women in these countries.

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.

“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 study 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.

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 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.

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