Echo 1 Study

Echo - evidence for contraceptive options and HIV Outcomes trial.

There is concern that DMPA (Depo-Provera depot medroxyprogesterone acetate) may increase HIV acquisition

2500 women from Frere and Cecilia Makiwane Hospitals in East London, South Africa with no specific preference of contraception were asked to participate.

The Echo 1 Study commenced at Frere Maternity and Cecilia Makiwane Hospitals in July 2009.



Contraception in East London

One in four pregnant women who attend The East London Hospital Complex request pregnancy termination.

Survey of postpartum women (Mshweshwe 2007):

  • Two-thirds of women giving birth had unintended pregnany
  • Three quarters had used contraception (97% depot progestins)
  • Stopped for various reasons, mainly side-effects
  • Epidemic of preterm births from self-induced pregnancy termination
  • Majority of maternal and perinatal deaths are the result of unitended prgnancy


  • Train health professionals in conseling on contraceptive options and insertion of IUCD
  • Improve access to family planning through publicity programmes and provision of user-friendly services
  • Monitor and evaluate outcomes (including a randomized trial of Depot progestin vs IUD) and incorporate findings into the programme


Echo 1 Sub-study - Effects of DPMA vs IUD on depression and sexual functioning (Singata M PhD 2014)

  • Background: many women abandon contraception because of side-effects
  • DMPA (long acting reversible hormonal contraceptive birth control drug that is injected every 3 months) is most common contraceptive in South Africa
  • DMPA could have a possible effect on depression and sexual function
  • Method: indepth study on 242 women randomized to IUD or DMPA.
  • Setting: Frere and Cecilia Makiwane Hospitals, East London, South Africa
  • Recruited 242 postnatal women between 4 Dec 2012 to 20 March 2013
  • Telephone follow up to 234 women (97%) after 1 month
  • Telephone follow up to 230 women (95%) after 3 months
  • Beck Depression inventory (BDI)
  • Edinburgh Postnatal Depression Score (EPDS)
  • Arizona Sexual Experience Score (ASEX)
  • Results: inconclusive
  • Trend to more depression and sexual dysfunction with DMPA vs IUD
  • Possible effects of contraception methods on sexual function have implications for HIV acquisition
  • Further research justified