{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T13:47:32Z","timestamp":1776952052610,"version":"3.51.4"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,5,11]],"date-time":"2017-05-11T00:00:00Z","timestamp":1494460800000},"content-version":"vor","delay-in-days":130,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Introduction<\/jats:bold>: Preventing unintended pregnancies is important among all women, including those living with HIV. Increasing numbers of women, including HIV\u2010positive women, choose progestin\u2010containing subdermal implants, which are one of the most effective forms of contraception. However, drug\u2013drug interactions between contraceptive hormones and efavirenz\u2010based antiretroviral therapy (ART) may reduce implant effectiveness. We present four inter\u2010related perspectives on this issue.<\/jats:p><jats:p><jats:bold>Discussion<\/jats:bold>: First, as a case study, we discuss how limited data prompted country\u2010level guidance against the use of implants among women concomitantly using efavirenz in South Africa and its subsequent negative effects on the use of implants in general. Second, we discuss the existing clinical data on this topic, including the observational study from Kenya showing women using implants plus efavirenz\u2010based ART had three\u2010fold higher rates of pregnancy than women using implants plus nevirapine\u2010based ART. However, the higher rates of pregnancy in the implant plus efavirenz group were still lower than the pregnancy rates among women using common alternative contraceptive methods, such as injectables. Third, we discuss the four pharmacokinetic studies that show 50\u201370% reductions in plasma progestin concentrations in women concurrently using efavirenz\u2010based ART as compared to women not on any ART. These pharmacokinetic studies provide the biologic basis for the clinical findings. Fourth, we discuss how data on this topic have marked implications for both family planning and HIV programmes and policies globally.<\/jats:p><jats:p><jats:bold>Conclusion<\/jats:bold>: This controversy underlines the importance of integrating family planning services into routine HIV care, counselling women appropriately on increased risk of pregnancy with concomitant implant and efavirenz use, and expanding contraceptive method mix for all women. As global access to ART expands, greater research is needed to explore implant effectiveness when used concomitantly with newer ART regimens. Data on how HIV\u2010positive women and their partners choose contraceptives, as well as information from providers on how they present and counsel patients on contraceptive options are needed to help guide policy and service delivery. Lastly, greater collaboration between HIV and reproductive health experts at all levels are needed to develop successful strategies to ensure the best HIV and reproductive health outcomes for women living with HIV.<\/jats:p>","DOI":"10.7448\/ias.20.1.21396","type":"journal-article","created":{"date-parts":[[2017,5,17]],"date-time":"2017-05-17T19:35:12Z","timestamp":1495049712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Concomitant contraceptive implant and efavirenz use in women living with HIV: perspectives on current evidence and policy implications for family planning and HIV treatment guidelines"],"prefix":"10.1002","volume":"20","author":[{"given":"Rena 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