Effectiveness of the female condom in preventing HIV and sexually transmitted infections : a systematic review and meta-analysis
Date
2020-03-12
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: The effectiveness of female condoms for preventing HIV and sexually transmitted infections (STIs)
remains inconclusive. We examined the effects of female condoms on the acquisition of HIV and STIs.
Methods: We searched four databases, two trial registries, and reference lists of relevant publications in October
2018 and updated our search in February 2020. We screened search output, evaluated study eligibility, and
extracted data in duplicate; resolving differences through discussion. We calculated the effective sample size of
cluster randomised trials using an intra-cluster correlation coefficient of 0·03. Data from similar studies were
combined in a meta-analysis. We performed a non-inferiority analysis of new condoms relative to marketed ones
using a non-inferiority margin of 3%. We assessed the certainty of evidence using GRADE.
Results: We included fifteen studies of 6921 women. We found that polyurethane female condoms (FC1) plus male
condoms may be as effective as male condoms only in reducing HIV acquisition (1 trial, n = 149 women, RR 0.07,
95%CI 0.00–1.38; low-certainty evidence). However, the use of FC1 plus male condoms is superior to male condoms
alone in reducing the acquisition of gonorrhoea (2 trials, n = 790, RR 0.59, 95%CI 0.41–0.86; high-certainty evidence)
and chlamydia (2 trials, n = 790, RR 0.67, 95%CI 0.47–0.94; high-certainty evidence). Adverse events and failure rates
of FC1 were very low and decreased during follow up. Although the functionality of newer female condoms
(Woman’s, Cupid, Pheonurse, Velvet, and Reddy) may be non-inferior to FC2, there were no available studies
assessing their efficacy in preventing HIV and STIs.
Conclusion: The use of female plus male condoms is more effective than use of male condoms only in preventing
STIs and may be as effective as the male condom only in preventing HIV. There is a need for well conducted
studies assessing the effects of newer female condoms on HIV and STIs.
Description
CITATION: Wiyeh, A. B., et al. 2020. Effectiveness of the female condom in preventing HIV and sexually transmitted infections : a systematic review and meta-analysis. BMC Public Health, 20:319, doi:10.1186/s12889-020-8384-7.
The original publication is available at https://bmcpublichealth.biomedcentral.com
The original publication is available at https://bmcpublichealth.biomedcentral.com
Keywords
Female condoms -- Reviews, HIV (Viruses) -- Transmission, HIV (Viruses) -- Prevention, Sexually transmitted diseases -- Prevention, Systematic reviews (Medical research)
Citation
Wiyeh, A. B., et al. 2020. Effectiveness of the female condom in preventing HIV and sexually transmitted infections : a systematic review and meta-analysis. BMC Public Health, 20:319, doi:10.1186/s12889-020-8384-7