Seeking clarity about implant use among women living with HIV

Kenyan woman receiving information about birth control

Credit: Jonathan Torgovnik/Reportage by Getty Images

In recent years, studies have revealed that a leading HIV therapy, known as efavirenz-based ART, can reduce the effectiveness of the contraceptive implant, an increasingly popular and long-acting birth control method. At the same time, the implant still offers many advantages. In a 2015 Bixby study of women taking efavirenz-based ART, the implant still proved more effective than other hormonal methods, including oral contraceptive pills, at preventing pregnancy.

Faced with this complex set of facts, experts have wrestled with how to provide clear, nuanced guidance regarding the combined use of efavirenz and the implant. A new commentary, coauthored by Craig Cohen, MD, MPH, offers suggestions, including:

  • Continue to integrate family planning and HIV care to enable providers to offer the best, most comprehensive counseling to patients on both HIV care and family planning.

  • Ensure providers fully inform women about the risks of using the implant and efavirenz in combination—without oversimplifying information or disrespecting the decisions women ultimately make.

  • Improve the availability of effective alternatives to the implant, such as the non-hormonal IUD—especially in areas with high HIV prevalence.

  • Conduct more studies, especially ones that independently verify key variables, such as ART adherence and contraceptive use, vulnerable to self-report bias.

  • Conduct research to identify possible modifications to the implant and/or efavirenz-based regimens to optimize the effectiveness of their combined use.

  • Advocate for more rigorous testing of new drugs’ impacts on the effectiveness of contraceptives to avoid similar situations in the future.

According to coauthor Rena Patel, "The bottom line is that implants are still a very effective form of contraception, and women living with HIV should continue to be offered this option with appropriate counseling."