The World Health Organization (WHO) recently issued revised guidance on the use of the injectable contraceptives DMPA and NET-EN by women at high risk of HIV. WHO states “there continues to be evidence of a possible increased risk of HIV among progestogen-only injectable users.” Grading this evidence as “low-to-moderate” quality, WHO concluded that “uncertainty exists about whether this is due to methodologic issues with the evidence or a real biologic effect.” Based on the possible increased risk and women’s right to informed choice, WHO has changed the Medical Eligibility Criteria (MEC) grade for DMPA and NET-EN from MEC Category 1 “use without restriction” to MEC Category 2 “benefits outweigh theoretical or proven risks.”
The World Health Organization recommends that all contraceptive methods should remain accessible to women at high risk of HIV; however, women at high risk who choose to use DMPA or NET-EN should be counselled about the possible increased risk of HIV and how to reduce this risk. As uncertainty remains, WHO also noted the need for additional high-quality data.
The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study is an ongoing randomized trial that seeks to provide definitive information on the risk of HIV acquisition associated with different contraceptive methods. The ECHO Management Committee issued a statementabout the WHO guidance change and AVAC developed helpful materials describing the change, including a plain language explanation of the MEC categories.