Contraceptive Depot Medroxyprogesterone Acetate Research Articles

Effect of progestin-based contraceptives on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls.

Adolescent girls bear a disproportionate burden of both the HIV epidemic and unintended pregnancies; yet important questions remain unanswered regarding the effects of hormonal contraceptives on the vaginal immune microenvironment, which can impact HIV susceptibility in this group. Multiple studies report genital immune alterations associated with the progestin-based contraceptive Depot medroxyprogesterone acetate (DMPA) in adult women, but there is little available data in adolescents. The objective of this longitudinal cohort study was to evaluate the effects of short-term use of three progestin-based contraceptives, levonorgestrel intrauterine device (LNG-IUD), subdermal etonogestrel (ETNG), and injectable DMPA, on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls. Fifty-nine sexually active, HIV-uninfected girls aged 15-19, were recruited from the Washington DC metro area and self-selected into Control (condoms only), combined oral contraceptive pills, LNG-IUD, ETNG and DMPA groups. Vaginal swabs were collected at baseline prior to contraceptive use and at 3-month follow-up visit. Vaginal secretions were tested for pro-inflammatory (IL-1α, IL-1β, TNF-α, IL-6, IL-8, MIP-3α, IP-10, RANTES, MIP-1α, MIP-1β) and anti-inflammatory/anti-HIV (Serpin-A1, Elafin, Beta-Defensin-2, SLPI) immune biomarkers using ELISA and for anti-HIV activity using TZM-bl assay. Vaginal microbiome was evaluated using 16S rRNA gene sequencing. Data were analyzed using SAS Version 9. Among the 34 participants who completed both visits, no significant changes in median biomarker concentrations, HIV inhibition and microbiome composition were observed between baseline and follow-up visits for any of the contraceptive groups. IL-8 (p<0.01), MIP-3α (0.02), Elafin (p = 0.03) and RANTES (p<0.01) differed significantly by race whereas IL-6 was significantly different by age (p = 0.03). We conclude that 3-month use of LNG-IUD, ETNG and DMPA have minimal effects on adolescent vaginal immune microenvironment, and therefore unlikely to impact HIV risk. Future studies with larger sample size and longer follow-up are recommended to continue to evaluate effects of contraceptives on the lower genital tract immunity and susceptibility to sexually transmitted infections.

Acceptance, Adherence, and Side Effects of Depot Medroxyprogesterone Acetate: A Prospective Observational Study.

Introduction In India, one of the world's most populous and swiftly growing countries, it is crucial to prioritize the utilization of safe and effective contraception, as contraceptive strategies play a pivotal role in bolstering community health. It is widely acknowledged that ensuring appropriate timing and spacing of pregnancies is crucial for the well-being of reproductive, maternal, neonatal, child, and adolescent health. Adoption of reversible or spacing contraceptive methods can significantly enhance women's health outcomes by reducing the occurrence of undesired, closely timed, and mistimed pregnancies. Consequently, in response to the pressing need for dependable contraception in India, this study seeks to assess the acceptance, adherence, and side effects of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) among its users. Methods This prospective observational study was done at the State Government Taluk Hospital in the Cuddalore District of Tamil Nadu from July 2022 to October 2022. A total of 40 women of reproductive age who opted for DMPA as their contraceptive method and met the inclusion criteria were recruited through a purposive sampling method. A structured questionnaire was used to collect the data. Results The majority of the participants were women aged 21-25 years (n=14; 35%). The participants were predominantly Hindu(n=39; 97.5%), and 35 (87.5%) had completed higher secondary education. All participants (n=40; 100%) resided in rural areas and the majority were homemakers. A significant proportion of the participants had two children (n=21; 52.5%), and all of them received information on DMPA primarilyfrom health personnel. At the initial point of data collection, three-fourths of them took the first dose(n=13; 32.5%)and only a few took more than three doses (n=3; 7.5%).In the third month, the results showed a drop in DMPA use, which indicates a lower adherenceparticularly linked to side effects like irregular bleeding (n=15; 37.5%) and amenorrhea (n=9; 22.5%). Furthermore, 35 (87.5%) of the women chose DMPA for birth spacing due to its efficacy and convenience, with few initiating it during postpartum (n=4; 10%) and post-abortal (n=1; 2.5%) periods.The reasons for continuing DMPA use included efficacy (n=20; 50%), discreet usage (n=15; 37.5%), and curiosity (n=13; 32.5%). Half of the participants reported no side effects.The study identified associations between DMPA users and the number of living children and occupational statusinferring that DMPA contraception is used forspacing births. Conclusion The results of this study imply that the use and adherence to injectable contraceptive DMPA need to be strengthened among rural women. Thus, the study suggests incorporating information, education, and communication strategies, to enhance awareness among rural women about injectable contraceptives.

A STUDY ON ACCEPTANCE AND COMPLIANCE OF DEPOT MEDROXY PROGESTERONE ACETATE FOR POST-PARTUM CONTRACEPTION IN A TERTIARY CARE CENTRE IN EASTERN INDIA

Objectives: Our aim was to determine the proportion of women accepting injection depot medroxyprogesterone acetate (DMPA) for postpartum contraception, its incidence of side effects, and discontinuation rates reasons for attrition. Methods: A prospective cohort study was conducted in the department of obstetrics and gynecology at a tertiary care hospital for 1 year. All eligible women were given a choice of contraceptive options after proper counseling for postpartum patients at the time of discharge and at 6 weeks, thereafter, and post-abortion patients immediately after MTP. A specially designed modified pro forma from the DMPA reference manual was used to collect the data of women attending the hospital. Result: A total of 240 women were included in the study. Most of the women (51.67%) were in the reproductive age group, 46.67% of women had 2 or more children, and most of the women (70.41%) were not used any family planning method earlier. The largest proportion of women (81.25%) were in the postpartum period. Irregular bleeding/spotting (39.08%) was the most common side effect. A larger portion of the women (36.5%) discontinued the injections due to side effects. Conclusion: It should be available as a first-line method to all who wish to opt for reversible methods of contraceptive.

Hubungan Jenis Dan Lama Penggunaan Kontrasepsi Hormonal Terhadap Gangguan Menstruasi Pada Wanita Usia Subur Di Klinik Pratama Vina Kecamatan Medan Baru Kota Medan Tahun 2023

According to the World Health Organization (WHO) in 2017 contraceptive use has increased in many parts of the world, especially in Asia and Latin America and is lowest in Sub-Saharan Africa. Globally, users of modern contraception have increased significantly from 35% in 1970 to 63% in 2017. The 2019 Indonesia Health Profile data shows that most active family planning participants choose injections and pills as contraceptives and are even very dominant (more than 80 %) compared to other methods; inject (63.7%), Pill (17.0%), Implant (7.4%), IUD/IUD (7.4%), Condom (1.2%), MOW (Women's Operative Method) (2 .7%), MOP (Male Operative Method) (0.5%). (RI Ministry of Health, 2020). The side effect of hormonal contraception is disruption of menstruation. The main side effects of DMPA (Depot Medroxyprogesterone Acetate) contraception and implants are menstrual disorders in the form of amenorrhea, spotting, changes in cycles, frequency, length of menstruation and amount of blood loss. The side effects of a contraceptive method are a factor that needs to be considered in determining the decision to continue using the contraceptive method (Hartanto, 2013). The type of research used in this research is analytic with a cross sectional approach. Cross sectional is a research approach that emphasizes the time of measurement/observation of independent variable data and depends only once at a time. The research sampling technique is total sampling. This research will be conducted at the Pratama Vina Clinic, Medan Baru District, Medan City in 2023. The results of the chi-squere test d. There is a significant relationship between the type of hormonal contraception and menstrual disorders in women of childbearing age at the Pratama Vina Clinic, Medan Baru District, Medan City, in 2023 (p= 0.013) and there is a significant relationship between the length of use of hormonal contraception and menstrual disorders in women of childbearing age at the Pratama Vina Clinic, Medan Baru District, Medan City in 2023 (p=0.031).

The Progestin Medroxyprogesterone Acetate Affects HIV-1 Production in Human Lymphoid Tissue Explants in a Dose-Dependent and Glucocorticoid-like Fashion.

The association between the use of the injectable contraceptive depot medroxyprogesterone acetate and HIV-1 susceptibility has been addressed mainly in respect to the changes occurring in the female genital mucosa and blood. However, one of the main sites of HIV-1 pathogenesis is lymphoid organs. To investigate the immunoregulatory effect of medroxyprogesterone acetate (MPA) at this site, human tonsillar tissue explants were infected ex vivo with either a CCR5 (BaL) or CXCR4 (LAI) HIV-1 variant and the release of p24gag and cytokines was measured in culture supernatant. The response to MPA was compared with that elicited by treatment with progesterone (P4) and dexamethasone (DEX), which selectively binds the glucocorticoid receptor, in donor-matched explant cultures. MPA treatment reduced the replication of both tested HIV-1 strains as well as the production of the mediators of inflammation IL-1β, IL-17A and CCL5, but not CCL20, in a similar way to DEX, whereas P4 had no effect on HIV-1 replication. The magnitude of both MPA and DEX-mediated responses was proportional to the length of exposure and/or administered dose. Blockage of the progesterone and glucocorticoid receptors with mifepristone abolished all observed changes in HIV-1 and cytokine production, and was associated with increased IL-22 levels in HIV-infected explants. Our data indicate that elevated doses of MPA may affect the immune responses in lymphoid tissue in a glucocorticoid-like fashion with an immediate impact on local HIV-1 replication.

Antigen Presenting Cells Link the Female Genital Tract Microbiome to Mucosal Inflammation, With Hormonal Contraception as an Additional Modulator of Inflammatory Signatures.

The microbiome of the female genital tract (FGT) is closely linked to reproductive health outcomes. Diverse, anaerobe-dominated communities with low Lactobacillus abundance are associated with a number of adverse reproductive outcomes, such as preterm birth, cervical dysplasia, and sexually transmitted infections (STIs), including HIV. Vaginal dysbiosis is associated with local mucosal inflammation, which likely serves as a biological mediator of poor reproductive outcomes. Yet the precise mechanisms of this FGT inflammation remain unclear. Studies in humans have been complicated by confounding demographic, behavioral, and clinical variables. Specifically, hormonal contraception is associated both with changes in the vaginal microbiome and with mucosal inflammation. In this study, we examined the transcriptional landscape of cervical cell populations in a cohort of South African women with differing vaginal microbial community types. We also investigate effects of reproductive hormones on the transcriptional profiles of cervical cells, focusing on the contraceptive depot medroxyprogesterone acetate (DMPA), the most common form of contraception in sub-Saharan Africa. We found that antigen presenting cells (APCs) are key mediators of microbiome associated FGT inflammation. We also found that DMPA is associated with significant transcriptional changes across multiple cell lineages, with some shared and some distinct pathways compared to the inflammatory signature seen with dysbiosis. These results highlight the importance of an integrated, systems-level approach to understanding host-microbe interactions, with an appreciation for important variables, such as reproductive hormones, in the complex system of the FGT mucosa.

An updated review on the effects of depot medroxyprogesterone acetate on the mucosal biology of the female genital tract.

BackgroundAccess to safe, effective, and affordable contraception is important for women’s health and essential to mitigate maternal and fetal mortality rates. The progestin‐based contraceptive depot medroxyprogesterone acetate (DMPA) is a popular contraceptive choice with a low failure rate and convenient administration schedule.AimIn this review, we compiled observational data from human cohorts that examine how DMPA influences the mucosal biology of the female genital tract (FGT) that are essential in maintaining vaginal health, including resident immune cells, pro‐inflammatory cytokines, epithelial barrier function, and the vaginal microbiomeMaterials and MethodsThis review focused on the recent published literature published in 2019 and 2020.ResultsRecent longitudinal studies show that DMPA use associates with an immunosuppressive phenotype, increase in CD4+CCR5+ T cells, and alterations to growth factors. In agreement with previous meta‐analyses, DMPA use is associated with minimal effects of the composition of the vaginal microbiome. Cross‐sectional studies associate a more pro‐inflammatory relationship with DMPA, but these studies are confounded by inherent weaknesses of cross‐sectional studies, including differences in study group sizes, behaviors, and other variables that may affect genital inflammation.Discussion & ConclusionThese recent results indicate that the interactions between DMPA and the vaginal mucosa are complex emphasizing the need for comprehensive longitudinal studies that take into consideration the measurement of multiple biological parameters.

Depot medroxyprogesterone acetate (DMPA) enhances susceptibility and increases the window of vulnerability to HIV-1 in humanized mice

The progestin-based hormonal contraceptive Depot Medroxyprogesterone Acetate (DMPA) is widely used in sub-Saharan Africa, where HIV-1 is endemic. Meta-analyses have shown that women using DMPA are 40% more likely than women not using hormonal contraceptives to acquire Human Immunodeficiency Virus (HIV-1). Therefore understanding how DMPA increases susceptibility to HIV-1 is an important public health issue. Using C57BL/6 mice and our previously optimized humanized mouse model (NOD-Rag1tm1Mom Il2rgtm1Wjl transplanted with hCD34-enriched hematopoietic stem cells; Hu-mice) where peripheral blood and tissues are reconstituted by human immune cells, we assessed how DMPA affected mucosal barrier function, HIV-1 susceptibility, viral titres, and target cells compared to mice in the diestrus phase of the estrous cycle, when endogenous progesterone is highest. We found that DMPA enhanced FITC-dextran dye leakage from the vaginal tract into the systemic circulation, enhanced target cells (hCD68+ macrophages, hCD4+ T cells) in the vaginal tract and peripheral blood (hCD45+hCD3+hCD4+hCCR5+ T cells), increased the rate of intravaginal HIV-1 infection, extended the window of vulnerability, and lowered vaginal viral titres following infection. These findings suggest DMPA may enhance susceptibility to HIV-1 in Hu-mice by impairing the vaginal epithelial barrier, increasing vaginal target cells (including macrophages), and extending the period of time during which Hu-mice are susceptible to infection; mechanisms that might also affect HIV-1 susceptibility in women.

Ovariectomized mice and postmenopausal women exhibit analogous loss of genital epithelial integrity.

ABSTRACT Roughly half of all postmenopausal women are affected by the genitourinary syndrome of menopause (GSM). Symptoms of GSM, including vaginal irritation and dyspareunia, occur as reduced estrogen (E) production elicits loss of elasticity and other changes in genital tract tissue. While the use of the injectable contraceptive depot-medroxyprogesterone acetate (DMPA) likewise lowers serum E concentrations in reproductive age women and is associated with decreased genital levels of the cell-cell adhesion molecules desmoglein-1 (DSG1) and desmocollin-1 (DSC1) and impaired genital epithelial barrier function, the relevance of these findings to women in menopause is uncertain. Exploring the impact of menopause on genital epithelial integrity herein, we detected significantly lower levels of DSG1 and DSC1 in ectocervical tissue from menopausal and postmenopausal vs premenopausal women. Using ovariectomized (OVX) mice as a menopause model, we comparably saw significantly lower vaginal tissue levels of DSG1 and DSC1 in OVX mice vs. mice in estrus. Compared to estrus-stage mice and E-treated OVX mice, DMPA-treated ovary-intact mice and OVX mice also exhibited significantly reduced genital epithelial barrier function, greater susceptibility to genital herpes simplex virus type 2 infection, and delayed clearance of genital Chlamydia trachomatis infection. Current studies thus identify analogous loss of genital epithelial integrity in OVX mice and menopausal and postmenopausal women. By showing that loss of genital epithelial integrity is associated with increased mouse susceptibility to bacterial and viral pathogens, our findings also prioritize the need to resolve if reduced genital epithelial integrity in postmenopausal women is a significant risk factor for genital infection.

Comparison of Depot Medroxyprogesterone Acetate and Postpartum Intrauterine Contraceptive Device in a Teaching Institute of Rural Bengal: A Longitudinal Cohort Study

Introduction: Contraception is one of the proximate determinants of fertility and the most important predictor of fertility transition. Depot Medroxy Progesterone Acetate (DMPA) and Intrauterine contraceptive device share some common features- both are Long Acting and Reversible Contraceptives (LARC), but the mechanisms are different. DMPA is a noninvasive, hormonal manoeuvre IUCD is an invasive, nonhormonal one. Aim: To compare the acceptance and reasons for refusal or non-compliance between DMPA and Postpartum Intrauterine Contraceptive (PPIUCD). Materials and Methods: A longitudinal cohort study was done in which total of 110 post partum women (55 in each group) using either DMPA or IUCD were selected randomly and were interviewed and followed up for minimum of six months. Data (variables- number of candidates accepting or refusing PPIUCD or DMPA) from the questionnaires were entered in Microsoft Office Excel 2007 and was transferred to IBM SPSS software, version 20.0 (SPSS Inc. Chicago, IL, USA). Pearson’s Chi-square test was used for variables and p-values were calculated using to find out the statistical significance of the variables and p-value &lt;0.05 was considered statistically significant. Results: The overall acceptance of DMPA (87.3%) was found to be much more than that of PPIUCD (63.6%). In respect to different age groups, the acceptances of both PPIUCD and DMPA were significantly higher in women of age group 21-25. In respect to parity, acceptance of PPIUCD was more in women with one child, whereas the acceptances of DMPA were almost similar in women with either one or two children. Women using PPIUCD, 36.4% refused to continue with the method, whereas only 12.7% of DMPA users refused further injections, the main reason for both the groups being the same irregular bleeding. Conclusion: The acceptance as well as compliance of DMPA as a method of postpartum contraception is much better than PPIUCD in women of this part of part of rural Bengal.

Depot Medroxyprogesterone Acetate Use and Blood Lead Levels in a Cohort of Young Women.

Background:Injectable contraceptive use is common, with 74 million users worldwide. Use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) is associated with bone mineral density loss. We hypothesize that increased bone resorption with DMPA use allows for mobilization of the toxic metal lead stored in bone to blood, presenting users with increased systemic exposure to lead.Objective:The objective of our study was to investigate the association between current DMPA use and blood lead concentrations.Methods:We conducted a cross-sectional analysis using enrollment data from the Study of Environment, Lifestyle & Fibroids (SELF), a cohort of 1,693 African-American women who were 23–35 years of age. Data on DMPA use were collected by computer-assisted telephone interview. Blood lead concentrations were measured in whole blood samples among 1,548 participants (91% of cohort). We estimated the adjusted percent difference in blood lead concentrations and 95% confidence intervals (CI) between current DMPA users and nonusers using multivariable linear regression.Results:Geometric mean blood lead concentration was (95% CI: 0.67, 0.71). After adjustment, current DMPA users (7% of cohort) had blood lead concentrations that were 18% higher than those of nonusers (95% CI: 8%, 29%). Similar associations were observed with additional analyses to assess for potential bias from smoking, DMPA-induced amenorrhea, use of estrogen-containing contraceptives, having given birth in the prior year, and history of medical conditions or current medication use associated with bone loss.Discussion:Our results indicate that current DMPA use is associated with increased blood lead concentrations. Further research, particularly in populations highly exposed to lead, is warranted to consider tradeoffs between the adverse effects of lead on human health and the importance of DMPA as a contraceptive option to prevent unintended pregnancy. https://doi.org/10.1289/EHP7017

Reduced Desmosomal Cadherin Levels in Genital Epithelium of Postmenopausal Women Also Develop in Ovariectomized Mice with Increased Susceptibility to Viral and Bacterial Genital Pathogens

Background: The genitourinary syndrome of menopause affects about half of all women in menopause and includes symptoms of vaginal burning, dyspareunia, and urinary urgency. These symptoms stem from lower serum estrogen levels in postmenopausal women that cause reduced tissue elasticity and other genital tract changes. While the hypoestrogenemia induced in reproductive age women using the progestin-only contraceptive depot-medroxyprogesterone acetate (DMPA) decreases genital levels of the cell-cell adhesion molecules desmoglein-1 (DSG1) and desmocollin-1 (DSC1) and impairs genital epithelial barrier function, relevance of these findings to postmenopausal women is uncertain. Methods: We compared ectocervical DSG1 and DSC1 levels in premenopausal vs. postmenopausal women. Using ovariectomized mice to model the hypoestrogenic state in postmenopausal women, we explored effects of reduced ovarian function on genital epithelial integrity barrier function and genital pathogen susceptibility. Findings: Compared to premenopausal women, ectocervical tissue from women in menopause had significantly lower levels of DSG1 and DSC1. Likewise, Dsg1 and Dsc1 levels were significantly reduced in OVX mice vs. estrus-stage mice. Consistent with these data, DMPA-treated and OVX mice displayed significant compromise of genital epithelial barrier function and compared to estrus-stage mice or OVX mice treated with estrogen, were more susceptible to genital herpes simplex virus type 2 infection and less effectively cleared genital Chlamydia trachomatis infection. Interpretation: Our studies identify analogously reduced genital epithelial integrity in postmenopausal women and OVX mice and indicate that reduced ovarian function alters host response to bacterial and viral pathogens. Our results also spotlight the need to resolve if weakened genital epithelial integrity in postmenopausal women represents an important risk factor for genital infection. Funding Statement: This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD094634) and Stanford University School of Medicine. Declaration of Interests: Authors have no conflicts of interest to declare. Ethics Approval Statement: Prior to induction, all proposed mice studies were approved by the Stanford University Institutional Animal Care and Use Committee.

Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa.

IntroductionSome observational data suggest that the progestogen injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase a woman’s risk of HIV acquisition but a randomized clinical trial did not find a statistically significant increase in HIV risk for women using DMPA compared to two other methods. However, it could not rule out up to 30% increased HIV risk for DMPA users. We evaluate changes to contraceptive method mix in South Africa under different assumptions about the existence and strength of a possible undetected relationship between DMPA use and HIV risk.MethodsA mathematical model was developed to simulate the ongoing HIV epidemic and contraceptive method mix in South Africa to estimate how changes in method mix could impact HIV‐ and reproductive health‐related outcomes. We made different assumptions about the relationship between DMPA use and HIV risk, from no relationship to a 30% increase in HIV risk for women using DMPA. Scenario analyses were used to investigate the impact of switching away from DMPA predominance to new patterns of contraceptive use.ResultsIn South Africa, the HIV‐related benefits of reduced DMPA use could be as great as the harms of increased adverse reproductive health outcomes over 20 years, if DMPA did increase the risk of HIV acquisition by a relative hazard of infection of 1.1 or greater. A reduction in DMPA use among HIV‐positive women would have no benefit in terms of HIV infections, but would incur additional negative reproductive health outcomes. The most important driver of adverse reproductive health outcomes is the proportion of women who switch away from DMPA to no contraceptive method.ConclusionsIf there is any real increased HIV risk for DMPA users that has not been detected by the recent randomized trial, a reduction in DMPA use could reduce the ongoing number of new HIV infections. However, such a change would place more women at risk of adverse reproductive health effects. It is imperative that these effects are minimized by focusing on expanding access to safe, effective and acceptable alternative contraceptive methods for all women.

Regular Use of Depot Medroxyprogesterone Acetate Causes Thinning of the Superficial Lining and Apical Distribution of Human Immunodeficiency Virus Target Cells in the Human Ectocervix.

BackgroundThe hormonal contraceptive depot medroxyprogesterone acetate (DMPA) may be associated with an increased risk of acquiring human immunodeficiency virus (HIV). We hypothesize that DMPA use influences the ectocervical tissue architecture and HIV target cell localization.MethodsQuantitative image analysis workflows were developed to assess ectocervical tissue samples collected from DMPA users and control subjects not using hormonal contraception.ResultsCompared to controls, the DMPA group exhibited a significantly thinner apical ectocervical epithelial layer and a higher proportion of CD4+CCR5+ cells with a more superficial location. This localization corresponded to an area with a nonintact E-cadherin net structure. CD4+Langerin+ cells were also more superficially located in the DMPA group, although fewer in number compared to the controls. Natural plasma progesterone levels did not correlate with any of these parameters, whereas estradiol levels were positively correlated with E-cadherin expression and a more basal location for HIV target cells of the control group.ConclusionsDMPA users have a less robust epithelial layer and a more apical distribution of HIV target cells in the human ectocervix, which could confer a higher risk of HIV infection. Our results highlight the importance of assessing intact genital tissue samples to gain insights into HIV susceptibility factors.

HIV, progestins, genital epithelial barrier function, and the burden of objectivity†.

Contributions from a diverse set of scientific disciplines will be needed to help individuals make fully informed decisions regarding contraceptive choices least likely to promote HIV susceptibility. This commentary recaps contrasting interpretations of results from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial, a study that compared HIV risk in women using the progestin-only injectable contraceptive depot medroxyprogesterone acetate (DMPA) vs. two other contraceptive choices. It also summarizes results from basic and translational research that establish biological plausibility for earlier clinical studies that identified enhanced HIV susceptibility in women using DMPA.

Determinants of injectable depot medroxyprogesterone acetate contraception among women of reproductive age: A study from Southern Haryana, India

Introduction: The safety and effectiveness of Depot Medroxyprogesterone Acetate (DMPA) (available by the name of “Antara” in Government of India supply) has resulted in inclusion of this injectable contraceptive in the basket of family planning choices and thus has opened the way for clients to avail of a safe, effective, and hassle-free method with full confidentiality, which is also free of cost in public health facilities all over India. Material and Methods: This community-based study with cross-sectional design was conducted during April 2019–October 2019. During first 3 months of the study, all the females who adopted the DMPA contraception were included in the study and the factors for opting DMPA were assessed. Results: Among those who had previously used contraceptives, oral pills were the most prevalent method. Most of the clients who opted to DMPA agreed that they switched because of privacy and confidentiality attached to DMPA. The side effects were reported by more than four-fifth of subjects, and the most common side effects were irregular spotting per vaginally, amenorrhea, and weight gain. Conclusion: The present study has shown some light regarding the factors responsible for injectable DMPA uptake as a family planning method and the facilitators and barriers to consistent injectable DMPA use. The study findings are expected to be utilized for framing policies to improve compliance of DMPA and making it more acceptable, client-friendly initiative.

What impact could DMPA use have had in South Africa and how might its continued use affect the future of the HIV epidemic?

IntroductionSome studies suggest that use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase susceptibility to HIV infection. We aim to determine the influence that such an association could have had on the HIV epidemic in South Africa.MethodsWe simulate the heterosexual adult HIV epidemic in South Africa using a compartmental model stratified by age, behavioural risk group, sex, male circumcision status and contraceptive use. We model two possible scenarios: (1) The “With Effect” scenario assumes that DMPA increases susceptibility to HIV infection by 1.20‐fold (95% confidence interval 1.06 to 1.36) based on a combination of the results of a recent randomised controlled trial (ECHO trial) and a number of observational studies. (2) The “No Effect” scenario assumes that DMPA has no effect on HIV acquisition risk. We calculate the difference in HIV‐related outcomes between the With Effect and No Effect scenarios to determine the potential impact that DMPA use could have had on the HIV epidemic.ResultsA causal association between DMPA and HIV acquisition could have caused 430,000 (90% of model runs 160,000 to 960,000) excess HIV infections and 230,000 (90,000 to 470,000) AIDS deaths in South Africa from 1980 to 2017. These figures represent 4.3% (1.6% to 9.6%) and 6.9% (2.6% to 15.2%) of the total modelled estimates of HIV infections and AIDS deaths respectively in South Africa in that period. Of the additional infections, 36% (25% to 48%) would have occurred among men. If DMPA use continues at current levels, a potential causal association could cause an additional 130,000 (50,000 to 270,000) infections between 2018 and 2037. The excess infections would have required an additional 640,000 (190,000 to 1,660,000) years of ART from 1980 to 2017, and a further 2,870,000 (890,000 to 7,270,000) years of ART from 2018 to 2037.ConclusionsIf there is a causal association between DMPA use and HIV risk, it could have substantially increased the scale of the HIV epidemic in South Africa, affecting not only the users of DMPA, but also their partners and the wider population. The magnitude of this potential effect demands careful data collection and a careful consideration of policy choices for contraception in settings with large HIV epidemics.

Contraceptive method switching among women living in sub-Saharan Africa participating in an HIV-1 prevention trial: a prospective cohort study

ObjectiveLong-acting reversible contraceptive (LARC) method uptake has been low within the context of HIV prevention trials. Within a multinational study (MTN-020/ASPIRE), the Contraceptive Action Team improved LARC accessibility and uptake. In this secondary analysis, we determined the rate of contraceptive method continuation among the women enrolled. Study designASPIRE was a randomized, double-blinded, placebo-controlled phase III safety and effectiveness study of the Dapivirine Vaginal Ring for HIV-1 prevention. Between 2012 and 2014, sexually active women aged 18–45 from Malawi, South Africa, Uganda and Zimbabwe were enrolled. All participants were required to use contraception for enrollment to the study and could choose between all highly effective contraceptive methods available in their respective countries. Women were seen monthly and could change methods at any time. Continuation rates from study enrollment to 6 and 12 months were determined. ResultsThe overall contraceptive method continuation rate was 77% (1972/2551) at 6 months and 66% (1694/2551) at 12 months. The 6- and 12-month continuation rates were highest for implantable contraceptives (89%, 82%) followed by copper intrauterine device (83%, 77%). Rates of continuation for injectable contraceptives depot medroxyprogesterone acetate (80%, 69%) and norethisterone enanthate (71%, 54%) were higher than for oral contraceptives, which were continued at 47% at 6 months and 35% at 12 months. The continuation rates of all methods did not differ by users with and without previous contraceptive experience. ConclusionsLARC methods have the highest rates of continuation at 12 months and should be routinely offered in the context of HIV prevention trials in sub-Saharan Africa. ImplicationsIntrauterine devices and contraceptive implant continuation was high at 12 months among women participating in an HIV prevention trial in sub-Saharan Africa and LARCs and should be routinely offered.

Thyroid function during the first year of use of the injectable contraceptive depot medroxyprogesterone acetate

Purpose: The aim of the study was to evaluate thyroid function profile as a possible factor influencing weight and body composition variation in new users of depot medroxyprogesterone acetate (DMPA). Materials and methods: A prospective, non-randomised, comparative study was conducted at the University of Campinas, Brazil. Women aged 18–40 years with a body mass index (BMI) less than 30 kg/m2, normal oral glucose tolerance test, no known diseases, and using no medication, who opted to use DMPA were paired by age (±1 year) and BMI (±1 kg/m2) with women initiating copper intrauterine device (IUD) use. The main outcome measures were thyroid function profile, weight, and body composition, as measured by dual-energy X-ray absorptiometry. We used repeated measures ANOVA to perform comparisons between times and groups. Results: We evaluated 28 DMPA users and 24 IUD users who completed the 12-month follow-up. We observed that FT4 levels were higher at 12 months (compared to baseline) in the DMPA group (p < .0001) and that FT4/FT3 ratio had increased in both groups. Additionally, at 12 months, total body mass had increased around 2 kg and lean mass increased in the DMPA group compared to the IUD group; there was also an increase in weight, BMI, total body mass, and fat mass when compared to baseline. Conclusions: No changes in thyroid function occurred that could explain the weight increase observed in DMPA users. Trial registration: ClinicalTrials.gov identifier: NCT01527526.

Perbandingan kadar HDL dan LDL akseptor Depo Medroksi Progesteron Asetat dengan IUD

Abstract&#x0D; The use of contraceptive depot medroxyprogesterone acetate (DMPA) increasing lately, but some studies suggest has the side effects of weight gain and contraceptives that have side effect in lipid metabolism. Therefore, about 35% of acceptors of DMPA in the first year to stop the use of DMPA. The objective of this study was to determine the differences of lipid profile between acceptors DMPA with acceptors IUD. This was a obcervational study with cross sectional study. The study wasdone at health center Lubuk Buaya in Padang and at laboratory of Biochemistry Departement in Medical Faculty of Andalas University from Januari until September 2016. The subjects were consisted of two groups, each group had 26 subjects. The examination for LDL and HDL used an enzymatic colorimetric method CHOD-PAP. Data was analyzed using analysis of t-test with p &lt; 0.05 was considered to be significantly different. HDL levels average in Depo Medroxyprogesterone Acetate was 87,54±14,28 mg/dl and IUD was 75,90±8,67 mg/dl with p &lt; 0.05 (significantly difference). Levels of LDL means there is no significantly difference between DMPA and IUD acceptors (p&gt; 0.05). This research concluded that there isa significant difference on average levels of HDL in the Depo Medroxyprogesterone Acetate and IUD but levels of LDL there is no significantly difference. The clinically lipid profile in the two groups is in normal range.&#x0D;