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DMPA and HIV: why we need a trial

  • Helen Rees for The ECHO Consortium
    Author Footnotes
    1 The ECHO Consortium is a multiorganizational collaborative team developing a protocol for a randomized controlled trial of hormonal contraception and HIV. The ECHO Consortium comprises Jared Baeten, Deborah Baron, Ward Cates, Connie Celum, Tsungai Chipato, Stephanie Combes, Deborah Donnell, Peter Gichangi, G. Justus Hofmeyr, Charles Morrison, Nelly Mugo, Kavita Nanda, Thes Palanee, Helen Rees, Petrus Steyn, Douglas Taylor and Marleen Temmerman.
  • Author Footnotes
    1 The ECHO Consortium is a multiorganizational collaborative team developing a protocol for a randomized controlled trial of hormonal contraception and HIV. The ECHO Consortium comprises Jared Baeten, Deborah Baron, Ward Cates, Connie Celum, Tsungai Chipato, Stephanie Combes, Deborah Donnell, Peter Gichangi, G. Justus Hofmeyr, Charles Morrison, Nelly Mugo, Kavita Nanda, Thes Palanee, Helen Rees, Petrus Steyn, Douglas Taylor and Marleen Temmerman.
      Recent articles by Ralph et al. [
      • Ralph L.J.
      • McCoy S.I.
      • Hallett T.
      • Padian N.
      Next steps for research on hormonal contraception and HIV.
      ,
      • Ralph L.
      • McCoy S.
      • Hallet T.
      • Padian N.
      Research on hormonal contraception and HIV (reply).
      ] and Gollub and Stein [
      • Gollub E.L.
      • Stein Z.
      Research on hormonal contraception and HIV.
      ], as well as an accompanying commentary by Jones [
      • Jones H.S.
      Time to focus on improving the contraceptive method mix and let go of unanswerable questions.
      ] in the current issue of Contraception, have challenged the concept of conducting a randomized trial to determine whether injectable depot medroxyprogesterone acetate (DMPA) increases the risk of HIV acquisition. They all raise concerns about the evidence, the methodology, the ethics, the feasibility and the return on investment of such an undertaking. While those authors acknowledge the uncertainty of the evidence regarding the effect of hormonal contraception, particularly DMPA, on increased HIV risk, they argue that the observational data are of sufficiently high quality to inform women of the potential risks and recommend against investing in a randomized trial to answer the question.
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