Previous studies have suggested that certain hormonal contraceptive methods, including intramuscular depot medroxyprogesterone acetate (DMPA-IM), may increase women’s susceptibility to HIV acquisition. In this randomized, open-label trial, 7829 women living in areas of high HIV incidence in Africa were randomly assigned to receive DMPA-IM (n=2609), a copper intrauterine device (IUD) (n=2607) or levonorgestrel implant (n=2613) to compare these contraceptive methods. The primary endpoint was incident HIV infection in the modified intention-to-treat population, including all randomised participants who were HIV negative at enrollment and who contributed at least one HIV test. Researchers found that 397 HIV infections occurred (incidence 3.81 per 100 woman-years, 95% CI 3.45 to 4.21). Of these, 143 occurred in the DMPA-IM group (incidence 4.19 per 100 woman-years, 95% CI 3.54 to 4.94), 138 in the copper IUD group (incidence 3.94 per 100 woman-years, 95% CI 3.31 to 4.66), and 116 in the LNG implant group (incidence 3.31 per 100 woman-years, 95% CI 2.74 to 3.98). Based on the modified intention-to-treat analysis, there was no significant difference in HIV risk among the methods evaluated. This study shows, however, that the incidence of HIV in this population of women seeking contraception is high, thus underlining the need for integration of HIV prevention within contraceptive services for African women.
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