TY - JOUR T1 - Reduced Effectiveness of Contraceptive Implants for Women Taking the Antiretroviral Efavirenz (EFV): Still Good Enough and for How Long? JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 528 LP - 531 DO - 10.9745/GHSP-D-15-00356 VL - 3 IS - 4 AU - James D Shelton Y1 - 2015/12/01 UR - http://www.ghspjournal.org/content/3/4/528.abstract N2 - EFV clearly reduces effectiveness of implants. However, the reduced effectiveness still appears better compared with short-acting methods overall, at least for the initial period of implant use, and may be acceptable to many women. We need better data on effectiveness, especially over the long term and on whether ENG implants (Implanon) might be more effective than LNG implants (Jadelle). Communicating the risk of pregnancy to clients under these circumstances is very challenging. In the longer term, providing an alternative to EFV, such as dolutegravir, might solve this problem.The antiretroviral (ARV) efavirenz (EFV) is now recommended for first-line antiretroviral therapy (ART) by the World Health Organization (WHO).1 And since WHO now recommends ART for all people living with HIV,2 that makes virtually all the some 13 million women in sub-Saharan Africa living with HIV3 candidates for extended EFV use.At the same time, contraceptive implants have many attractive features4 and are the fastest growing method of contraception in sub-Saharan Africa—taking a markedly increasing share of the contraceptive method mix. The reduced effectiveness of implants due to an interaction with EFV could result in many unwanted pregnancies among vulnerable women and undermine confidence in an outstanding contraceptive method.By reducing contraceptive hormone levels. The very high contraceptive efficacy of implants comes from consistent release of low but highly effective levels of progestin in the blood. However, EFV speeds up the normal degradation of contraceptive progestins including those in implants (though not that of the injectable DMPA), lowering the progestin blood levels by roughly half.5 … ER -