Bill & Melinda Gates Foundation issues statement on the ECHO trial results

Today, the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial* released study results comparing the relative risk of HIV acquisition among women using one of the following three contraceptive methods: the injectable contraceptive DMPA-IM; the Jadelle LNG-implant; and a copper intrauterine device, or IUD.

A statement follows from Chris Elias, President of Global Development at the Bill & Melinda Gates Foundation:

“We’re encouraged the ECHO trial found no substantial difference in HIV acquisition among the methods tested because millions of women around the world rely on modern contraception to make informed decisions about their health and futures,” said Chris Elias, President of Global Development at the Bill & Melinda Gates Foundation. “Nonetheless, it’s concerning to see persistently high HIV incidence among women seeking contraception in eastern and southern Africa. This study underscores the urgent need to improve integrated care that includes high-quality counseling and a range of contraceptive and HIV prevention options.”


There has been a longstanding question as to whether an association exists between hormonal contraceptive use and HIV acquisition among women who are at high risk for HIV. In 2015, the Gates Foundation along with USAID, WHO and other partners launched the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial to assess the comparative risk of HIV acquisition among women using one of the following three hormonal contraceptive methods: injectable DMPA-IM, LNG implant/Jadelle and copper intrauterine devices (IUDs). The study enrolled 7,830 women across 12 sites in Kenya, South Africa, eSwatini and Zambia, and was the most comprehensive study attempted to date to investigate the question.

The ECHO study did not result in a statistically significant difference in the risk of acquiring HIV among women using any of the three contraceptive methods included in the trial. All contraceptive methods studied were found to be safe, effective and generally well-accepted by the women using them. The high incidence of HIV among women involved in the study, regardless of the contraceptive used, demonstrates the persistent threat women seeking contraception face when living in high HIV prevalence communities or settings.

The results also draw renewed focus to the need for improved quality of counseling and a range of contraceptive and HIV prevention options, so women can make informed decisions to protect their health and future.

The ECHO trial was designed and implemented to high methodological, ethical and regulatory standards. An independent Data and Safety Monitoring Board regularly met to review the trial data to ensure the health and safety of the 7,830 participating women involved in the study were not compromised.

* Funding for the ECHO trial was provided by the Bill & Melinda Gates Foundation, USAID, SIDA, UNFPA, NICHD and the Medical Research Council of South Africa. USAID and the South African government donated the contraceptives used in the trial.

About the Bill & Melinda Gates Foundation

Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life. Based in Seattle, Washington, the foundation is led by CEO Sue Desmond-Hellmann and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett.

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