Track C report by Elizabeth Bukusi
THAC0501 Women living
with HIV are still missing highly effective contraception. Results from the
ANRS-Vespa2 Study, 2011, France
Annabel Desgrées du
patterns of women living with HIV in France in 2007. 56%
were women from African countries and migrant.
African women were
younger than other women, more likely to have children and had partners (
similar) and had HIV for about 6 years.
Contraception : did
not different between women from SSA and others . One in 5 did not use any or
used traditional. Only 20% used highly effective methods. No difference between
use of highly effective between SSA women and others. No statistically significant difference on
use when comparing health insurance, visit to gynecologist in the last 12 months, or any cardiovascular
One in 4 women not
using any modern method among HIV positive women. Among migrants, women with children are more
likely to be using contraception .
Employment highly correlated
Among French and
other migrant women, causal partners associated with low sexual activity and
less likely to use contraception.
The study had the
whole of France but did not ask about unwanted pregnancy.
Condom is the most used method for HIV positive
women. Dual protection not widely promoted.
Conclusion : dual use not
promoted . No difference in contraception access for migrant and non
migrant / French women.
Question : Did you
look at the relationship between Highly effective contraception and the viral load.
Answer: This will
need to be verified with the first author
Question : Are you
planning to do any work with the care provider
since the physicians attitudes may be the one’s driving the lack of
contraception options or may only promote condoms. Will you do any work with
Answer : informal
discussions held with the practitioners. The providers seem to think that if one is
HIV positive they must use condoms so they will need discussions to make them
think of other contraception options that they can offer the women.
Question : Was there
a difference among the French and the immigrants, was there difference in the uptake of implants and IUCD
Answer: the French contraception
of highest choice is the pill. The others are not as widely used so analysis
not broken down into the other contraceptives and for the pill there was no difference.
Question : WHO
office India ; What was the uptake in terms of post partum IUCD compared to the
This is cross sectional
so no data on post partum available as the questions were asked about previous
Question : Malawi .
What guidelines and policies would you provide in order to promote the use of a
range of contraception.
Answer : yes, this is the first analysis and the idea is to
come back to the practitioners to improve the better use of and access of contraception
for HIV positive women- and guidelines would be provided an policies put in
THAC0502 Condoms for contraception: patterns
of contraceptive use among female sex workers in eThekwini District,
KwaZulu-Natal, South Africa
Patterns of contraceptive use among female sex
workers in KZN. Women in RSA have challenges with RH problems. High HIV and
STI. High pregnancy rates. Sex workers
at higher risk. Compare baseline at KZN at E-thekwiny .
The study is called DIFFER
– multi country study including Kenya and India and Mozambique . Started in 2011 to 2016. Focus is on baseline
Aim to improve
services for RH among women.
Implementing a diagonal service for women.
For FSW - respondent driven sampling- RDS for recruitment and general women from the
region from clinics. Looked at network
size to determine if appropriate .
FSW had lower
education and had no current stable visiting partner and 80% of the clinic women had a regular partner. In the last 5
years, 40% had an unplanned pregnancy among the FSW . Women from the clinics - most
had not planned the last pregnancy. Contraception use FSW 88% and 35% among
contraception was condom with use high
among the FSW compared to the General population where over half use modern
methods. The injection was the most
popular for the general population of women.
There is a move to re train and
reintroduce the IUCD. Condom use higher among the FSW but not 100%.
HIV Status , self
reported was similar, in the two group sunder
50% and when measured among the FSW it was 67% ( still under 50% for general
population0. FSW get condoms from the
Govt clinic. They rely on condoms for contraception
and do not use it 100 %. As per the current progressive Strategic plan for RH,
dual methods to be promoted and multipurpose prevention technology -MPT will be
good for this population.
Qs : Comment : IUCD
were not recommended for women with high risk for STI and HIV is this still the
recommendation will be presented shortly. RSA uses the WHO guidelines.
Question : age group 18-45 whey not younger or why not
Answer : only 18 and
older as guidelines only allow those over 18 and doing research under 18
requires parental consent. But it is right that this population s vulnerable
and requites focused attention.
THAC0503 Hormonal contraception and HIV
infection: results from a large individual participant data meta-analysis
Charles Morrison : FHI360.
Meta analysis of HIV
and contraception :
benefits of contraception are well accepted
From observational studies
; Determine if different contraceptives including hormonal contraceptives increase
the risk of HIV acquisition.
Only included those
using HV and HIV prospectively and at multiple end points, women 14-49 and detect at least 15 sero
conversion. 18 studies included in the
final data set. A total of 37,000 women
HR -No association for
OC, 1.6 for Depo and 1.5 for net N.
Adjusted for age,
DMPA and COC 1.43
DMPA and Net en 1.32
Net En and CC 1.1?
by the region of the study.
Limitations of the
differences in design and selection biases and residual confounding
Conclusion :Use of DMPA but not COC or Net En associated in
increased risk of HIV acquisition .
The importance of
a well planned RCT would be
More contraception options which are safe are needed for women
at risk for HIV
Question : Would
this be adequate evidence for change in recommendations ? No, more stringent evidence
Question South African : How fare are the discussion on
when an RCT can be done to sort out this issue ? How far is the discussion to
Answer : ECHO trial
in discussion, have site selection. Funding is being worked on to allow this to
THAC0504 Weighing 17 years of evidence: does hormonal
contraception increase HIV acquisition risk among Zambian women in discordant
17 years of evidence
does hormonal contraception increase the risk for HIV acquisition
HC used in areas
where HIV prevalence is high eg Zambia where it is 14%.
WHO recommended HC
at category 1 and advised condom use
Male positive and
female negative serodiscordant couples.
Followed up for 3 months intervals and contraception provided.
Hormonal methods, Implant
( Norplant and Jadelle ) inaction DMPA nd COC
Interest on time to
conversion – linked or unlinked infections to the partners.
Of 1393 , 18 %
seroconverted and most infections were linked.
Most women not using a method or condoms.
incidence for OCPs was marginally
statistically significant but for implants and injections not significant
In the Multivariate model there was no increase risk controlling
for age, genital ulceration, inflammation , semen present in wet prep smear.
Even when analyzed
by genetically linked infections, no increased risk observed.
Conclusion :No association after controls. More counseling needed for OC use, and during pregnancy
Question: Why did
the men not get on treatment and do know the viral load and how this affected the analysis
Answer : Men did
initiate treatment and censored once on treatment.
Qs was there a
comparison of women who did not use any contraception since they were grouped
with condom use group?
Answer: yes this was
taken care of in the sensitivity analysis
Qs : from Boston
hospital. How was inflammation measured and was there a difference within the
was self report, and on examination and also for any infections detected BV, Chlamydia
and Candida. No difference noted.
THAC0505LB HIV and contraception - complex issues for safe choice:
the latest recommendations from the World Health Organization (WHO
Marylyne Gaffield. WHO
MEC – medical Eligibily
criteria for the last 20 years.
Evidence based for guidelines for contraceptive use for women and men.
This includes women
at risk , those living with HIV and those who are on HAART. This is issued ahead of the guidelines which
will be done by March 2015.
There are 4
or conditions for which no restrictions
Can be used
but careful follow up
clinical judgment and access to treatment
risk and should not be used.
This can be made
whether it is an imitation or continuing the method.
Where information is
limited then it is limited to whether it can be used ( 1 or 2) or not ( 3,4)
WHO requirements using
the PICO system has been used ( population intervention comparison outcome) .
Does the use of HC increase
the risk for acquisition ? does it accelerate the disease progression
Does it increase the
female to male transition ? Are there any interaction of HC and ARV ?
provided for quality fo each evidence provided.
HC : 1, all those
listed, no restriction for women at high risk of HIV . But for DMPA and Net N women at high risk
may or may not increase the risk of HIV acquisition and they should be
progression : no change in
For female to male
transmission of HIV ; No change, low
Does it affect ART
: no changes in the recommendation , low quality of the studies 2
use HIV infected mild ( Stage 1 or 2 )
or HIV infected moderate or severe( Stage 3or 4)
recommendation for levonogesterone for imitation for IUCD, can initiate state 1
or 2, but for severe disease 3 or 4, do not start until condition improves but
if had it can continue to use.
Evidence for contraceptive
effectiveness and for effectives of the ART. Very little data available. This
is available on the WHO. Offer for
NNRTI, NRTI And for integrase and Protease inhibitors. Now offer specific recommendation on the
drugs in specific. For Efavienz and
Nevirapine no restrictions for stage 1 and 2.
provided depending on the stage of the HIV disease for specific drugs.
Conclusion : Some changes in recommendations for specific
issues for ART, terminology. No change in recommendations fro HC use .
Clarification on dual use for those at risk maintained.