title: Preexposure prophylaxis is efficacious for HIV-1 prevention among women using depot medroxyprogesterone acetate for contraception.
abstract: OBJECTIVE
  To evaluate preexposure prophylaxis (PrEP) efficacy for HIV-1 prevention among women using depot medroxyprogesterone acetate (DMPA) for contraception and men whose HIV-1-infected partners use DMPA.
  
  
  METHODS
  Secondary analysis of data from a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among heterosexual Kenyan and Ugandan HIV-1 serodiscordant couples.
  
  
  METHODS
  PrEP efficacy for HIV-1 prevention was compared among HIV-1-uninfected women using DMPA versus no hormonal contraception and among HIV-1 uninfected men whose HIV-1-infected female partners used DMPA versus no hormonal contraception.
  
  
  RESULTS
  Of 4747 HIV-1 serodiscordant couples, 901 HIV-1-uninfected women used DMPA at some point during follow-up, 1422 HIV-1-uninfected women used no hormonal contraception, 1568 HIV-1-uninfected men had female partners who used DMPA, and 2626 men had female partners who used no hormonal contraception. PrEP efficacy estimates for HIV-1 prevention, compared with placebo, were similar among women using DMPA and those using no hormonal contraception (64.7 and 75.5%, adjusted interaction P = 0.65). Similarly, for men whose female partners used DMPA, PrEP efficacy did not differ from men whose partners used no hormonal contraception (90.0 versus 81.7%, adjusted interaction P = 0.52).
  
  
  CONCLUSIONS
  PrEP is efficacious for HIV-1 prevention among women using DMPA and men whose partners use DMPA, suggesting PrEP could mitigate the potential increased HIV-1 acquisition and transmission risks that have been associated with DMPA use. Women at risk for HIV-1 choosing DMPA could maintain this contraceptive method and add PrEP to achieve prevention of unintended pregnancy and HIV-1.
authors.affiliation: aDepartment of Global Health bDepartment of Medicine cDepartment of Epidemiology dPediatrics & Laboratory Medicine eDepartment of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA fCenter for Clinical Research, Kenya Medical Research Institute, Nairobi gDepartment of Reproductive Health, Moi University, Eldoret hDepartment of Obstetrics & Gynecology, University of Nairobi and Kenyatta National Hospital iCenter for Microbiology, Kenya Medical Research Institute, Nairobi, Kenya jVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA kDepartments of Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada. *The Partners PrEP Study Team is listed in the Acknowledgements.
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.forename: Edwin
authors.initials: E
authors.lastname: Were
authors.forename: James
authors.initials: J
authors.lastname: Kiarie
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Andrew
authors.initials: A
authors.lastname: Mujugira
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Frenkel
authors.forename: Deborah
authors.initials: D
authors.lastname: Donnell
authors.forename: Allan
authors.initials: A
authors.lastname: Ronald
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003692:Delayed-Action Preparations / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007630:Kenya; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents; D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate