Overview

The World Health Organization (WHO) convened a Guideline Development Group (GDG) meeting from 29 to 31 July 2019 to review global guidance on contraceptive eligibility for women at high risk of HIV acquisition to and determine whether revisions to the fifth edition of the Medical eligibility criteria for contraceptive use (MEC) were needed. The issue was deemed critical, particularly for sub-Saharan Africa, given the high lifetime risk of acquiring HIV alongside the importance of hormonal contraception in offering women and adolescent girls’ choice and in reducing their risk of unintended pregnancy, a common threat to the health, well-being and lives of women and adolescent girls.

The GDG consisted of 28 participants from 19 countries, including experts in family planning and HIV, representatives from affected populations, clinicians, epidemiologists, researchers, programme managers, policy-makers and guideline methodologists.

Contents

• Acknowledgements
• Abbreviations
• Executive Summary
• 1. Background
• 2. Methods of Guideline Review and Development
  • 2.1. Guideline Development Group
  • 2.2. Guideline development process
  • 2.3. Evidence Retrieval
  • 2.4. Evidence Synthesis
  • 2.5. Formulation of recommendations
• 3. Summary of the Evidence
  • 3.1. Progestogen-only injectables
  • 3.2. Progestogen-only implants
  • 3.3. Progestogen-only pills
  • 3.4. Intrauterine devices
  • 3.5. Combined hormonal contraceptives
  • 3.6. Additional evidence considered by the GDG
• 4. Recommendations
  • 4.1. Recommendations for contraceptive use among women at high risk of HIV infection
  • 4.2. Rationale
• 5. Implications for Policy-Makers, Programme Managers and Health-Care Providers
  • 5.1. A woman’s risk of HIV should not restrict her contraceptive choice
  • 5.2. Efforts to expand access to contraceptive options must continue
  • 5.3. A renewed emphasis on HIV and STI prevention services is urgently needed
• 6. Knowledge Gaps and Areas for Research
  • 6.1. Contraceptive methods and HIV acquisition
  • 6.2. HIV prevention
  • 6.3. Community involvement
  • 6.4. Increased funding for high-quality, policy-relevant research
• 7. Dissemination of this Guidance Statement
• References
• ANNEX 1. Guideline Development Group and Evidence Secretariat
• ANNEX 2. Declarations of Conflicts of Interest
• ANNEX 3. Grade Evidence Profiles
• ANNEX 4. Evidence-to-Decision Table for Hormonal Contraceptive Methods and Intrauterine Devices (IUDS)
• ANNEX 5. Systematic Reviews

Suggested citation:

Contraceptive eligibility for women at high risk of HIV. Guidance statement: recommendations on contraceptive methods used by women at high risk of HIV. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.

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