Strong Health Systems for Better Family Planning Services and HIV Prevention and Care


MSH calls for improved access to contraceptives and women’s autonomy over family planning choices

Arlington, VA—June 18, 2019—The long-awaited results of the ECHO study published in The Lancet last week show that three common contraceptives—copper IUD, LNG implant, and the DMPA-IM shot—have no substantial effect on HIV risk. However, data from the study also revealed a high incidence of HIV infection among women who participated in the trial.

“These findings underscore MSH’s long-standing practice of building strong health systems that put women at the center of their reproductive health,” said Katherine Wright, MSH’s Senior Technical Advisor for Maternal and Reproductive Health. “Women should have access to a range of contraceptive options and quality counseling that includes HIV information and care and helps them choose the best family planning method for them, free of stigma and discrimination.”

Through its pharmaceutical systems strengthening work, MSH supports countries in myriad efforts to improve access to and availability of essential medicines, including contraceptives. These efforts range from training health providers on dispensing practices to working with pharmacy managers to prevent medicine stock-outs and supporting health officials to create a better regulatory environment that enables access to affordable medicines for all.

MSH’s HIV and AIDS programs focus on strengthening systems for better HIV care and achieving the 95-95-95 goals (95% of all people living with HIV know their status; 95% of those are on sustained antiretroviral therapy; and 95% of those treated have viral suppression). MSH does this—currently in seven countries—by integrating high-quality HIV and other health services, such as family planning; improving health information systems and the use of data for decision making; strengthening health workforce planning and management; and more.

The rate of HIV acquisition of women in the study was high, at an average of 3.8% per year. This signals the urgent need to better integrate HIV prevention programs as a part of family planning, particularly in settings with high HIV prevalence. Access to a range of available contraceptive options is also important for women living with HIV.

“Our HIV programs are working hard to transition people living with HIV to TLD, the antiretroviral regimen recommended by the World Health Organization. For women of reproductive age who currently do not want to become pregnant, this should be accompanied by a consistent and reliable method of contraceptives of their choice,” said Sarah Konopka, MSH’s Principal Technical Advisor for HIV and AIDS. “By addressing supply-side issues, such as the availability of commodities, and health provider behavior and practices, we can help ensure that all women living with HIV have access to their preferred method of contraception.”

MSH also engages in evidence-based constructive activism to build political commitment, develop progressive policies, foster accountability, and mobilize increased funding for programs that improve women’s health, with a focus on reproductive rights.

The Evidence for Contraceptive Options and HIV Outcomes (ECHO) study randomly assigned HIV-negative women from the Kingdom of Eswatini, Kenya, South Africa, and Zambia to use one of the three contraceptive methods: the copper-releasing intrauterine device (Cu-IUD); a levonorgestrel (LNG) implant (Jadelle); or depot medroxyprogesterone acetate-intramuscular (DMPA-IM), also known as Depo-Provera. Women received counseling on family planning and HIV prevention and referral for oral pre-exposure prophylaxis where available. The study was funded by a consortium of donors: the Bill & Melinda Gates Foundation, the US Agency for International Development, the Swedish International Development Cooperation Agency, the United Nations Population Fund, and the Medical Research Council of South Africa. A key impetus for the trial was uncertainty about whether DMPA-IM increased women’s risk of getting HIV.