In Practice

Changes to the World Health Organization guideline on hormonal contraceptive eligibility for women at high risk of HIV: South African perspective and response

Z Nene, G J Hofmeyr, M Patel, M Panday, H Rees, M Makua, Y Pillay

Abstract


The World Health Organization (WHO) published guidelines for hormonal contraceptive eligibility for women at high risk of HIV in March 2017. This guidance followed from a technical consultative meeting convened by the WHO in December 2016, where all the available evidence on hormonal contraceptives and risk of HIV acquisition was reviewed. This was an expert meeting with representation from global experts in family planning and HIV management, including clinicians, epidemiologists, researchers and civil society. The guideline development group, through a consensus, made recommendations to change the medical eligibility criteria for contraceptive use from category 1 to category 2 for progestogen-only injectable contraceptives among women at high risk of HIV. There was no change in the recommendation for all other methods of hormonal contraception. The data that informed this decision are from observational studies, which have limitations; therefore, causality or association of hormonal contraception and risk of HIV acquisition have not been proven. This guidance will have an impact on countries that have a high HIV disease burden and where progestogen-only injectable contraceptives are the highest used, as in South Africa (SA). The information has to be communicated in line with the WHO’s sexual and reproductive health rights principles of ensuring that all women should receive evidence-based recommendations. This will empower them to make informed choices about their reproductive needs. This article seeks to clarify the decision-making process of the WHO and how the new recommendations were formulated. It also gives SA’s response to the guidance and a perspective of what informed the National Department of Health’s position, taking into account the effect this will have on SA’s contraceptive guidelines.


Authors' affiliations

Z Nene, Reproductive and Endocrine Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa

G J Hofmeyr, Effective Care Research Unit, Faculty of Health Sciences, University of Fort Hare, and Frere and Cecilia Makiwane Hospitals, East London, South Africa

M Patel, Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

M Panday, Family Planning Department, King Dinuzulu Hospital Complex and Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

H Rees, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa

M Makua, National Department of Health, Pretoria, South Africa

Y Pillay, National Department of Health, Pretoria, South Africa

Full Text

PDF (95KB)

Keywords

Sexual and reproductive health

Cite this article

South African Medical Journal 2018;108(8):629-631. DOI:10.7196/SAMJ.2018.v108i8.13160

Article History

Date submitted: 2018-07-25
Date published: 2018-07-25

Article Views

Abstract views: 339
Full text views: 297

Comments on this article

*Read our policy for posting comments here