The effect of dolutegravir-based ART on plasma etonogestrel levels among women with HIV using contraceptive implants in Botswana
Awarded 2018
Complex Family Planning Fellowship Research
Ian Bishop, MD, MPH
Columbia University

The etonogestrel (ENG) implant is the most effective contraceptive method available. However, its use is complicated in high-HIV prevalence settings because data show reduced implant efficacy during efavirenz-based (EFZ) ART therapy. New, more effective strategies for concomitant ART/implant use need to be identified. Dolutegravir-based (DTG) ART, first-line ART in many resource-rich countries, is now being introduced in Africa. This study will evaluate whether DTG/implant combination avoids drug-drug interactions that lead to unintended pregnancies and reduced contraceptive efficacy with EFZ. The proposed parallel-group study will take place in Gabarone, Botswana to compare steady state plasma concentrations of ENG in Botswanan implant-users with HIV in three groups; those receiving EFZ-based ART, DTG-based ART, and ART-naive women. A secondary aim will be to describe what proportion of women in each group have plasma ENG concentration levels below that needed for ovulation suppression; thus indicating compromised contraceptive efficacy. This question is of clinical importance for the whole of Africa as DTG use is expanded, and the answer will enable the development of evidence-based guidance to optimize contraceptive care for HIV-infected women.