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Free, C; Roberts, IG; Abramsky, T; Fitzgerald, M; Wensley, F (2011)
Publisher: BMJ Publishing Group
Journal: Journal of Epidemiology and Community Health
Languages: English
Types: Article
Subjects: sexual health, sexual behaviour, Essay, Contraception RB, 1506, contraception SA, sexually transdis
Background Effective condom use can prevent sexually transmitted infections (STIs) and unwanted pregnancy. We conducted a systematic review and methodological appraisal of randomised controlled trials (RCTs) of interventions to promote effective condom use. Methods We searched for all RCTs of interventions to promote effective condom use using the Cochrane Infectious Diseases Group's trials register (Oct 2006), CENTRAL (Issue 4, 2006), MEDLINE (1966 to Oct 2006), EMBASE (1974 to Oct 2006), LILACS (1982 to Oct 2006), IBSS (1951 to Oct 2006) and Psychinfo (1996 to Oct 2006). We extracted data on allocation sequence, allocation concealment, blinding, loss to follow-up and measures of effect. Effect estimates were calculated. Results We identified 139 trials. Seven out of ten trials reported reductions in ‘any STI’ with five statistically significant results. Three out of four trials reported reductions in pregnancy, although none was statistically significant. Only four trials met all the quality criteria. Trials reported a median of 11 (IQR 7–17) outcome measures. Few trials used the same outcome measure. Altogether, 10 trials (7%) used the outcome ‘any STI’, 4 (3%) self-reported pregnancy and 22 (16%) used ‘condom use at last sex’. Conclusions The results are generally consistent with modest benefits but there is considerable potential for bias due to poor trial quality. Because of the low proportion of trials using the same outcome the potential for bias from selective reporting of outcomes is considerable. Despite the public health importance of increasing condom use there is little reliable evidence on the effectiveness of condom promotion interventions.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. WHO. Global prevalence and incidence of selected curable sexually transmitted infections: overview and estimates. World Health Organization: Geneva, 2001.
    • 2. Alan Guttmacher Institute. Sharing responsibility: women, society and abortion. New York: Alan Guttmacher Institute, 1999.
    • 3. UNAIDS. AIDS epidemic update. Geneva: UNAIDS, 2003.
    • 4. Farr G, Gabelnick H, Sturgen K, et al. Contraceptive efficacy and acceptability of the female condom. Am J Public Health 1994;84:1960e4.
    • 5. Spruyt A, Steiner MJ, Joanis C, et al. Identifying condom users at risk for breakage and slippage: findings from three international sites. Am J Public Health 1998;88:239e44.
    • 6. Shepherd J, Weston R, Peersman G, et al. Interventions for encouraging sexual lifestyles and behaviours intended to prevent cervical cancer (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software, 2007.
    • 7. Johnson WD, Hedges LV, Diaz RM. Interventions to modify sexual risk behaviors for preventing HIV infection in men who have sex with men (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software, 2007.
    • 8. Oakley A, Fullerton D, Holland J. Behavioral interventions for HIV/AIDS prevention. AIDS 1995;9:479e86.
    • 9. Juni P, Altman DG, Egger M. Systematic reviews in health care: assessing the quality of controlled clinical trials. BMJ 2001;323:42e6.
    • 10. Chan AW, Hrobjartsson A, Haahr MT, et al. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA 2004;291:2457e65.
    • 11. Chan AW, Altman DG. Identifying outcome reporting bias in randomized trials on PUBMED: review of publications and survey of authors. BMJ 2005;330:753e6.
    • 12. Williamson PR, Gamble C. Identification and impact of outcome selection bias in meta-analysis. Stat Med 2005;24:1547e61.
    • 13. Furukawa TA, Watanabe N, Omori IM, et al. Association between unreported outcomes and effect size estimates in Cochrane meta-analyses [Letter]. JAMA 2007;297:468e70.
    • 14. Barne R, Shey C, Wiysonge U, Kongynyuy E. Female condom for preventing HIV and sexually transmitted infections. Cochrane library 2008. http://onlinelibrary.wiley. com/o/cochrane/clsysrev/articles/CD003652/frame.html.
    • 15. Higgins JPT, Green S, eds. Chapter 6: Searching for studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009. www.cochrane-handbook.org.
    • 16. Agresti A. An introduction to categorical data analysis. New York, NY: John Wiley & Sons, 1996.
    • 17. Der Simonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177e88.
    • 18. Hayes RJ, Alexander ND, Bennett S, et al. Design and analysis issues in cluster-randomized trials of interventions against infectious diseases. Stat Methods Med Res 2000;9:95e116.
    • 19. Higgins JPT, Green S. eds. Chapter 9: Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009.
    • 20. Boyer P, Shafer M, Shaffer R, et al. Evaluation of a cognitive-behavioral, group, randomized controlled intervention trial to prevent sexually transmitted infections and unintended pregnancies in young women. Prev Med 2005;40:420e31.
    • 21. Boyer CB, Barrett D, Peterman T, et al. Sexually transmitted disease (STD) and HIV risk in heterosexual adults attending a public STD clinic: evaluation of a randomized controlled behavioral risk-reduction intervention trial. AIDS 1997;11:359e67.
    • 22. Carey MP, Carey KB, Maisto S, et al. Reducing HIV-risk behavior among adults receiving outpatient psychiatric treatment: results from a randomized controlled trial. J Consult Clin Psychol 2004;72:252e68.
    • 23. Downs J, Murray P, Bruine de Bruin W, et al. Interactive video behavioral intervention to reduce adolescent females' STD risk: a randomized. Soc Sci Med 2004;59:1561e72.
    • 24. Imrie J, Stephenson J, Cowan F, et al. A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial. BMJ 2001;322:1451e6.
    • 25. Jemmott JB 3rd, Jemmot LS, Braverman P, et al. HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial. Arch Pediatr Adolesc Med 2005;159:440e9.
    • 26. Kamb ML, Fishbein M, Douglas J, et al. Efficacy of risk-reduction counselling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. JAMA 1998;7:1161e7.
    • 27. NIMH Multisite HIV Prevention Trial Group. The NIMH Multisite HIV Prevention Trial: reducing HIV sexual risk behavior. The National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial Group. Science 1998;280:1889e94.
    • 28. O'Donnell CR, O'Donnell L, Doval A, et al. Reductions in STD infections subsequent to an STD clinic visit. Using video-based patient education to supplement provider interactions. Sex Transm Dis 1998;25:161e8.
    • 29. Shain RN, Piper J, Newton E, et al. A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N Engl J Med 1999;340:93e100.
    • 30. Shain RN, Perdue ST, Piper JM, et al. Behaviors changed by intervention are associated with reduced STD recurrence: the importance of context in measurement. Sex Transm Dis 2002;29:520e9.
    • 31. DiClemente R, Wingwood G, Harrington K, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA 2004;292:171e9.
    • 32. Philliber S, Kaye J, Herrling S, et al. Preventing pregnancy and improving health care access among teenagers: an evaluation of the children's aid society-carrera program. Perspect Sex Reprod Health 2002;34:244e51.
    • 33. Shlay JC, Mayhugh B, Foster M, et al. Initiating contraception in sexually transmitted disease clinic setting: a randomized trial. Am J Obstet Gynecol 2003;189:473e81.
    • 34. Wight D, Raab G, Henderson M, et al. Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial. BMJ 2002;324:435.
    • 35. Feldblum PJ, Hatzell T, Van Damme K, et al. Results of a randomised trial of male condom promotion among Madagascar sex workers. Sex Transm Infect 2005;81:166e73.
    • 36. Branson BM, Peterman TA, Cannon R, et al. Group counseling to prevent sexually transmitted disease and HIV: a randomized controlled trial. Sex Transm Dis 1998;25:553e60.
    • 37. Cohen D, Dent C, MacKinnon D, et al. Condoms for men, not women. Results of brief promotion programs. Sex Transm Dis 1992;19:189e333.
    • 38. DiClemente R, Wingwood G, Harrington K, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA 2004;292:171e9.
    • 39. EXPLORE Study Team. Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet 2005;364:41e50.
    • 40. Gollub EL, French P, Loundou A, et al. A randomized trial of hierarchical counseling in a short, clinic-based intervention to reduce the risk of Sex Transm Dis in women. AIDS 2000;14:1249e55.
    • 41. Harvey B, Stuart J, Swan T. Evaluation of a drama-in-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial. Int J STD AIDS 2000;11:105e11.
    • 42. Kamali A, Quigley M, Nakiyingi J, et al. Syndromic management of sexuallytransmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. Lancet 2003;361:645e52.
    • 43. Shain RN, Piper J, Holden A, et al. Prevention of Gonorrhea and Chlamydia through behavioural intervention: results of two-year controlled randomized trial in minority women. Sex Transm Dis 2004;31:401e8.
    • 44. Egger M, Pauw J, Lopatatzidis A, et al. Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial. Lancet 2000;355:2101e5.
    • 45. Ehrhardt AA, Exner T, Hoffman S, et al. A gender-specific HIV/STD risk reduction intervention for women in a health care setting: short- and long-term results of a randomized clinical trial. AIDS Care 2002;14:147e61.
    • 46. Boekeloo BO, Schamus L, Simmens S, et al. A STD/HIV prevention trial among adolescents in managed care. Pediatrics 1999;103:107e15.
    • 47. Borgia P, Marinacci C, Schifano P, et al. Is peer education the best approach for HIV prevention in schools? Findings from a randomized controlled trial. J Adolesc Health 2005;36:508e16.
    • Health Psychol 1996;15:371e82.
    • Fitzgerald AM, Standon B, Terreri N, et al. Use of Western-based HIV risk-reduction interventions targeting adolescents in an African setting. J Adolesc Health 1999;25:52e61.
    • Kirby D, Korpi M, Adivi C, et al. An impact evaluation of project SNAPP: an AIDS and pregnancy prevention middle school program. AIDS Educ Prev 1997;9:44e61.
    • Kvalem IL, Sundet J, Rivo KI, et al. The effect of sex education on adolescents' use of condoms: applying the Solomon four-group design. Health Educ Q 1996;23:34e47.
    • Shrier LA, Ancheta R, Goodman E, et al. Randomized controlled trial of a safer sex intervention for high-risk adolescent girls. Arch Pediatr Adolesc Med 2001;155:73e9.
    • Stanton B, Harris C, Cottrell L, et al. Trial of an urban adolescent sexual risk-reduction intervention for rural youth: a promising but imperfect fit. J Adolesc Health 2006;38:55.
    • Stanton B, Li X, Ricardo I, et al. A randomized, controlled effectiveness trial of an AIDS prevention program from low-income African-American youths. Arch Pediatr Adolesc Med 1996;150:363e72.
    • Stanton BF, Li X, Kahihuata J, et al. Increased protected sex and abstinence among Namibian youth following a HIV risk-reduction intervention: a randomized, longitudinal study. AIDS 1998;12:2473e80.
    • Weeks K, Levy S, Gordon A, et al. Does parental involvement make a difference? The impact of parent interactive activities on students in a school-based AIDS prevention program. AIDS Educ Prev 1997;9:90e106.
    • Wenger NS, Greenberg JM, Hilborne LH, et al. Effect of HIV antibody testing and AIDS education on communication about HIV risk and sexual behavior. A randomized, controlled trial in college students. Ann Intern Med 1992;117:905e11.
    • Xu J, Jiyao W, Naiqing Z, et al. The effectiveness of an intervention program in the promotion of condom use among sexually transmitted disease patients. Chin J Epidemiol 2002;23:218e20.
    • AIDS 2005;19:1897e905.
    • Balmer DH, Gikundi E, Nasio J, et al. A clinical trial of group counselling for changing high-risk sexual behaviour in men. Couns Psychol Q 1998;11:33e43.
    • Cleary P, Van Devanter N, Steilen M, et al. A randomized controlled trial of an education and support program for HIVdinfected individuals. AIDS 1995;9:1271e78.
    • Fogarty LA, Heilig C, Armstrong K, et al. Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and atrisk women. Public Health Rep 2001;116:103e19.
    • Gielen AC, Fogarty L, Armstrong K, et al. Promoting condom use with main partners: A behavioral intervention trial for women. AIDS Behav 2001;5:193e204.
    • Jemmott JB 3rd, Jemmot LS, Fong G. Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial. JAMA 1998;279:1529e36.
    • Kelly JA, McAuliffe T, Sikkema K, et al. Reduction in risk behavior among adults with severe mental illness who learned to advocate for HIV prevention. Psychiatr Serv 1997;48:1283e8.
    • Kuchaisit C, Higginbotham N. An education intervention to increase the use of condoms for the prevention of HIV infection among male factory workers in Khon Kaen. J Clin Epidemiol 1996;49:13S.
    • Mansfield CJ, Conroy M, Emans S, et al. A pilot study of AIDS education and counseling of high-risk adolescents in an office setting. J Adolesc Health 1993;14:115e19.
    • Orr DP, Langefeld C, Katz B, et al. Behavioral intervention to increase condom use among high-risk female adolescents. J Pediatr 1996;128:288e95.
    • Scholes D, McBride C, Grothaus L, et al. A tailored minimal self-help intervention to promote condom use in young women: results from a randomized trial. AIDS 2003;17:1547e56.
    • Anon. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet 2002;356:103e112.
    • Wu Y, Stanton B, Galbraith J, et al. Sustaining and broadening intervention impact: a longitudinal randomized trial of 3 adolescent risk reduction approaches. Pediatrics 2003;111:32e8.
    • Choi K, Lew S, Vittinghoff E, et al. The efficacy of brief group counseling in HIV risk reduction among homosexual Asian and Pacific Islander men. AIDS 1996;10:81e7.
    • Kelly JA, Murphy DA, Sikkema KJ, et al. Community and HIV Prevention Research Network. Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative. Lancet 1997;350:1500e5.
    • Roffman RA, Picciano J, Ryan R, et al. HIV-prevention group counseling delivered by telephone: an efficacy trial with gay and bisexual men. AIDS Behav 1997;1:137e54.
    • Rosser BR, Bockting W, Rugg D, et al. A randomized controlled intervention trial of a sexual health approach to long-term HIV risk reduction for men who have sex with men: effects of the intervention on unsafe sexual behaviour. AIDS Edu Prev 2002;14:59e71.
    • Tudiver F, Myers T, Kurtz R, et al. The talking sex project: Results of a randomized controlled trial of small-group AIDS education for 612 gay and bisexual men.
    • Eval Health Prof 1992;83:26e42.
    • Acquir Immune Defic Syndr 2004;37:S68e77.
    • Belcher L, Kalichman S, Topping M. A randomized trial of a brief HIV risk reduction counseling intervention for women. J Consult Clin Psychol 1998;66:856e61.
    • Greenberg J, Hennessy M, MacGowan R, et al. Modeling intervention efficacy for high-risk women. The WINGS Project. Eval Health Prof 2000;23:123e48.
    • Kalichman SC, Browne-Sperling F, Cherry C. Effectiveness of a video-based motivational skills-uilding HIV risk-reducation intervention for inner-city African American men. J Consult Clin Psychol 1999;67:959e66.
    • Kelly JA, Murphy D, Washingtom C, et al. The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. Am J Public Health 1994;84:1918e22.
    • Sikkema KJ, Winett R, Lombard D. DeveNot Found In Databaselopment and evaluation of an HIV-risk reduction program for female college students. AIDS Educ Prev 1995;7:145e59.
    • St Lawrence JS, Crosby R, Belcher L, et al. Sexual risk reduction and anger management interventions for incarcerated male adolescents: A randomized controlled trial of two interventions. J Sex Educ Ther 1999;24:9e17.
    • Weinhardt L, Carey M, Carey K, et al. Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness. J Consult Clin Psychol 1998;66:680e4.
    • El-Bassel N, Witte SS, Gilbert L, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health 2003;93:963e9.
    • Kalichman SC, Rompa D, Cage M, et al. Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. Am J Prev Med 2001;21:84e92.
    • O'Leary A, Ambrose T, Raffaelli M, et al. Effects of an HIV risk reduction project on sexual risk behavior of low-income STD patients. AIDS Educ Prev 1998;10:483e92.
    • Hobfoll S, Jackcon A, Lavin J, et al. Reducing inner-city women's AIDS risk activities: a study of single, pregnant women. Health Psychol 1994;13:397e403.
    • Bellingham K, Gillies P. Evaluation of an AIDS education programme for young adults. J Epidemiol Community Health 1993;47:134e8.
    • Picciano J, Roffman R, Kalichman S, et al. A telephone based brief intervention using motivational enhancement to facilitate HIV risk reduction among MSM: A pilot study. AIDS Behav 2001;5:251e62.
    • Robert B, Rosser S. Evaluation of the efficacy of AIDS education interventions for homosexually active men. Health Educ Res 1990;5:299e308.
    • Stephenson JM, Strange V, Forrest S, et al; RIPPLE study team. Pupil-led sex education in England (RIPPLE study): cluster-randomised intervention trial. Lancet 2004;364:338e46.
    • 93. Swanson JM, Dibble S, Chapman L. Effects of psycho-educational interventions on sexual health risks and psycho-social adaptation in young adults with genital herpes. J Adv Nurs 1999;29:840e51.
    • 94. Tripiboon D. A HIV/AIDS prevention program for married women in rural northern Thailand. Aust J Prim Health 2001;7:83e91.
    • 95. Iguchi MY, Bux D, Lidz V, et al. Changes in HIV risk behavior among injecting drug users: the impact of 21 versus 90 days of methadone detoxification. AIDS 1996;10:1719e28.
    • 96. Avants SK, Usubiaga M, Doebrick C. Targeting HIV-related outcomes with intravenous drug users maintained on methadone: a randomized clinical trial of a harm reduction group therapy. J Subst Abuse Treat 2004;26:67e78.
    • 97. Cottler LB, Compton W, Abdallah A, et al. Peer-delivered interventions reduce HIV risk behaviors among out-of-treatment drug abusers. Public Health Rep 1998;113:31e41.
    • 98. Eldridge GD, St Lawrence J, Little C, et al. Evaluation of the HIV risk reduction intervention for women entering inpatient substance abuse treatment. AIDS Educ Prev 1997;9:62e76.
    • 99. Kotranski L, Semaan S, Collier K, et al. Effectiveness of an HIV risk reduction counseling intervention for out-of-treatment drug users. AIDS Educ Prev 1998;10:19e33.
    • Margolin A, Avants K, Warburton LA, et al. A randomized clinical trial of a manualguided risk reduction intervention for HIV-positive injection drug users. Health Psychol 2003;22:223e8.
    • Hershberger SL, Wood M, Fisher D. A cognitive-behavioral intervention to reduce HIV risk behaviors in crack and injection drug users. AIDS Behav 2003;7:229e43.
    • Sorensen JL, London J, Heitzmann C, et al. Psychoeducational group approach: HIV risk reduction in drug users. AIDS Edu Prev 1994;6:95e112.
    • Golombok S, Harding R, Sheldon J. An evaluation of a thicker versus a standard condom with gay men. AIDS 2001;15:245e50.
    • Steiner MJ, Hylton-Kong T, Figueroa JP, et al. Does a choice of condoms impact sexually transmitted infection incidence? A randomized, controlled trial. Sex Transm Dis 2006;33:31e5.
    • Benton KW, Jolley D, Smith A, et al. An actual use comparison of condoms meeting Australian and Swiss standards: results of a double-blind crossover trial. Int J STD AIDS 1997;8:427e31.
    • Renzi C, Tabet S, Stucky J, et al. Safety and acceptability of the reality condom for anal sex among men who have sex with men. AIDS 2003;17:727e31.
    • Macaluso M, Blackwell R, Carr B, et al. Safety and acceptability of a baggy latex condom. Contraception 2000;61:217e23.
    • Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996;276:637e9.
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