Behavioral interventions for improving condom use for dual protection

摘要: Background Unprotected sex is a major risk factor for disease, disability, and mortality in many areas of the world due to prevalence incidence sexually transmitted infections (STI) including HIV. The male condom one oldest contraceptive methods earliest method preventing spread When used correctly consistently, condoms can provide dual protection, i.e., against both pregnancy HIV/STI. Objectives We examined comparative studies behavioral interventions improving use. We were interested identifying associated with effective use as measured biological assessments, which objective evidence protection. Search methods Through September 2013, we searched computerized databases use: MEDLINE, POPLINE, CENTRAL, EMBASE, LILACS, OpenGrey, COPAC, ClinicalTrials.gov, ICTRP. wrote investigators missing data. Selection criteria Studies could be either randomized or nonrandomized. They intervention comparison another intervention, usual care, no intervention. experimental had an educational counseling component encourage improve It addressed well transmission HIV/STI. focus on female targeted individuals, couples, communities. Potential participants included heterosexual women men. Studies data from test results records outcome: pregnancy, HIV/STI, presence semen assessed marker, e.g., prostate-specific antigen. did not include self-reported protected unprotected sex, limitations recall social desirability bias. Outcomes at least three months after started. Data collection analysis Two authors evaluated abstracts eligibility extracted studies. For dichotomous outcomes, Mantel-Haenszel odds ratio (OR) 95% CI was calculated using fixed-effect model. Cluster trials various accounting clustering, such multilevel modeling. Most reports information calculate sample size. Therefore, presented reported by investigators. No meta-analysis conducted differences outcome measures. Main results Seven met our criteria. All controlled trials; six assigned clusters individuals. Sample sizes cluster-randomized ranged 2157 15,614; number 18 70. Four took place African countries, two USA, England. Three based mainly schools, community settings, during military training, clinic-based. Five provided tests national abortions live births. HIV HSV-2. other STI. showed significant difference between study groups HIV, but favorable effects evident some Two lower HSV-2 behavioral-intervention group compared usual-care group, adjusted rate ratios (ARR) 0.65 (95% 0.43 0.97) 0.67 0.47 0.97), while differ significantly. One also syphilis gonorrhea plus STI management group. ARR 0.58 0.35 0.96) 0.28 0.11 0.70), respectively. Another negative effect young versus control (ARR 1.93; 1.01 3.71). occurred among those only year intervention. Authors' conclusions We found few little clinical effectiveness promoting protection. find overall quality moderate low; losses follow up high. Effective are needed prevent HIV/STI transmission. Interventions should feasible resource-limited settings tested valid reliable measures.