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Meta-Analysis
. 2011 Sep 7;2011(9):CD007844.
doi: 10.1002/14651858.CD007844.pub2.

Behavioral interventions to promote condom use among women living with HIV

Fernanda T Carvalho  1 , Tonantzin R Gonçalves, Evelise R Faria, Jean A Shoveller, C A Piccinini, Mauro C Ramos, Lídia Rf Medeiros
Affiliations
Meta-Analysis

Behavioral interventions to promote condom use among women living with HIV

Fernanda T Carvalho et al. Cochrane Database Syst Rev. .

Abstract

Background: High rates of HIV infection among women of reproductive age have dramatic consequences for personal and public health. Prophylaxis during sexual intercourse in the form of condoms has been the most effective way to prevent both STI and HIV transmission among people living with HIV.

Objectives: To investigate the effectiveness of behavioral interventions in promoting condom use among women living with HIV.

Search strategy: We conducted a comprehensive literature search in several scientific databases, clinical trials databases, conference proceedings, and conference websites to identify studies produced between 1980 and May 2010 that met our selection criteria.

Selection criteria: Studies were included in the analysis if they conducted a randomized controlled trial that examined the effects of behavioral interventions on condom use among HIV-positive women; considered at least one HIV-related behavioral outcome (e.g., reported protected anal, vaginal, or oral sex) or biological outcome (e.g., acquisition of STIs); and one follow-up assessment three months or more after the intervention. Studies were assessed irregardless of langauge or publication status.

Data collection and analysis: We used random effects models to summarize odds ratios (ORs) that compared intervention and control groups with respect to a dichotomous outcome (consistent versus inconsistent condom use). We used funnel plots to examine publication bias and a χ(2) statistic to test for heterogeneity. The methodological and evidence quality was evaluated through risk of bias criteria and the GRADE system, respectively.

Main results: Five primary studies that collectively researched a total of 725 women living with HIV were analysed. When compared to standard care or minimal HIV support intervention, meta-analysis showed that behavioral interventions had no effect on increasing condom use among HIV-positive women. This finding was consistent at various follow-up meetings (3, 6, and 12-months) as well as over the entire 12-month follow-up period (OR= 0.82; 95% CI 0.65-1.04; p=0.11). Only one study presented adequate data to analyze the relationship between behavioral interventions and STI incidence. Studies included in this analysis demonstrated low risk of bias based on the risk of bias criteria. However, sample size was considered inadequate across all studies.

Authors' conclusions: Meta-analysis shows that behavioral interventions have little effect on increasing condom use among HIV-positive women. However, these findings should be used with caution since results were based on a few small trials that were targeted specifically towards HIV-positive women. To decrease sexual transmission of HIV among this population, we recommend interventions that combine condom promotion, family planning provision and counselling, and efforts to reduce viral loads among HIV-positive women and their partners (e.g., HAART treatment provision). New research is needed to address the needs of HIV-positive women, including an assessment of the impact of interventions that combine safer sexual behavior and harm reduction approaches.

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Conflict of interest statement

None

Figures

1
1
*Note: Figure shows an integrated view of the screening process considering the first comprehensive searches (performed 26‐28 May, 2009) were subsequently updated on 18‐21 May, 2010 to complete the review.
2
2
Forest plot of comparison: 1 Protected sex among women living with HIV in the baseline.
3
3
Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgments about each risk of bias item for each included study.
5
5
Funnel plot of comparison: 2 Increasing in protected sex among women living with HIV after intervention, outcome: 2.1 Time intervention.
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6
Forest plot of comparison: 2 Increase in protected sex among women living with HIV after intervention, outcome: 2.1 Time intervention.
1.1
1.1. Analysis
Comparison 1 Consistent condom use among women living with HIV, Outcome 1 Baseline.
2.1
2.1. Analysis
Comparison 2 Increasing in consistent condom use among women living with HIV after intervention, Outcome 1 Time intervention.
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