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Gallo MF, Norris AH, Turner AN. Female condoms: new choices, old questions. LANCET GLOBAL HEALTH 2013; 1:e119-20. [PMID: 25104250 DOI: 10.1016/s2214-109x(13)70070-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Maria F Gallo
- Division of Epidemiology, College of Public Health, Ohio State University, OH 43210, USA.
| | - Alison H Norris
- Division of Epidemiology, College of Public Health, Ohio State University, OH 43210, USA
| | - Abigail Norris Turner
- Division of Epidemiology, College of Public Health, Ohio State University, OH 43210, USA; Division of Infectious Diseases, College of Medicine, Ohio State University, OH, USA
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Harel O, Pellowski J, Kalichman S. Are we missing the importance of missing values in HIV prevention randomized clinical trials? Review and recommendations. AIDS Behav 2012; 16:1382-93. [PMID: 22223301 DOI: 10.1007/s10461-011-0125-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Missing data in HIV prevention trials is a common complication to interpreting outcomes. Even a small proportion of missing values in randomized trials can cause bias, inefficiency and loss of power. We examined the extent of missing data and methods in which HIV prevention randomized clinical trials (RCT) have managed missing values. We used a database maintained by the HIV/AIDS Prevention Research Synthesis (PRS) Project at the Centers for Disease Control and Prevention (CDC) to identify related trials for our review. The PRS cumulative database was searched on June 15, 2010 and all citations that met the following criteria were retrieved: All RCTs which reported HIV/STD/HBV/HCV behavioral interventions with a biological outcome from 2005 to present. Out of the 57 intervention trials identified, all had some level of missing values. We found that the average missing values per study ranged between 3 and 97%. Averaging over all studies the percent of missing values was 26%. None of the studies reported any assumptions for managing missing data in their RCTs. Under some relaxed assumptions discussed below, we expect only 12% of studies to report unbiased results. There is a need for more detailed and thoughtful consideration of the missing data problem in HIV prevention trials. In the current state of managing missing data we risk major biases in interpretations. Several viable alternatives are available for improving the internal validity of RCTs by managing missing data.
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Allen CF, Simon Y, Edwards J, Simeon DT. Factors associated with condom use: economic security and positive prevention among people living with HIV/AIDS in the Caribbean. AIDS Care 2011; 22:1386-94. [PMID: 20936539 DOI: 10.1080/09540121003720978] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In the Caribbean region, an estimated 1.1% of the population aged 15-49 is living with HIV. We aimed to measure factors associated with condom use, the primary form of positive prevention in the Caribbean, among people living with HIV (PLHIV) in its major agency advocating on behalf of PLHIV (the Caribbean Regional Network of People Living with HIV/AIDS, or CRN +). Condom use at last sex was selected for analysis from a broad-ranging cross-sectional survey (n=394) among PLHIV who were members of or received services from CRN+ in Antigua and Barbuda, Grenada, Trinidad and Tobago. PLHIV from CRN+ traced potential participants, administered informed consent procedures and carried out structured interviews. Fifty-four percent of respondents reported using a condom the last time they had sex. Condom use was positively associated with partner being HIV negative, disclosure of HIV status, alcohol use, economic security, education level and being employed. Multivariate logistic regression found independent associations between condom use and economic security (p=0.031; odds ratio (OR) for "enough" income 5.06; 95% CI 1.47-17.39), partner being HIV negative (p=0.036; OR 2.85; 95% CI 1.28-6.33) and being married (p=0.043; OR 2.86; 95% CI 1.03-7.91). Seventy-three percent of respondents reported inadequate family income, 26% reported an HIV-negative partner and 9% were married. Condom use appears to be motivated by protection of HIV-negative partners and spouses. Low socioeconomic status is associated with the overall percentage using condoms. Restriction to members of CRN+ limits generalisability of the findings. Nevertheless, the findings support the view that programmes for the socioeconomic empowerment of PLHIV are needed to slow the Caribbean HIV epidemic. Expectations for protection of different types of partners should be further explored in order to develop culturally appropriate interventions with couples.
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Affiliation(s)
- C F Allen
- Caribbean Health Research Council, St. Augustine, Trinidad and Tobago.
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Weaver MA, Joanis C, Toroitich-Ruto C, Parker W, Gyamenah NA, Rinaldi A, Omungo Z, Steiner MJ. The effects of condom choice on self-reported condom use among men in Ghana, Kenya and South Africa: a randomized trial. Contraception 2011; 84:291-8. [PMID: 21843696 DOI: 10.1016/j.contraception.2011.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Male condoms are readily available and affordable in many settings, but risky sexual acts still go unprotected. STUDY DESIGN This unblinded randomized trial, conducted in Ghana, Kenya and South Africa, was designed to assess the impact of providing a choice of condoms on self-reported use and uptake over 6 months. RESULTS We enrolled 1,274 men. The mean subject-specific proportion of protected acts with all partners increased from baseline to 6 months by 0.07 in the control group compared to 0.03 in the choice group (p=.025). The observed results were largely consistent across all three countries. In the choice group, men clearly preferred one condom type over the others, and this preference was consistent across all three countries. CONCLUSIONS Providing one type of male condom in public sector programs appears justified. Programs should not focus on the number of brands available, but should encourage effective promotion and consistent and correct use of available brands.
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Affiliation(s)
- Mark A Weaver
- FHI, P.O. Box 13950, Research Triangle Park, NC 27709, USA.
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Wetmore CM, Manhart LE, Wasserheit JN. Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future. Epidemiol Rev 2010; 32:121-36. [PMID: 20519264 DOI: 10.1093/epirev/mxq010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Globally, sexually transmitted infections (STIs) represent a significant source of morbidity and disproportionately impact the health of women and children. The number of randomized controlled trials testing interventions to prevent STIs has dramatically increased over time. To assess their impact, the authors conducted a systematic review of interventions to prevent sexual transmission or acquisition of STIs other than human immunodeficiency virus, published in the English-language, peer-reviewed literature through December 2009. Ninety-three papers reporting data from 74 randomized controlled trials evaluating 75 STI prevention interventions were identified. Eight intervention modalities were used: behavioral interventions (36% of interventions), vaginal microbicides (16%), vaccines (16%), treatment (11%), partner services (9%), physical barriers (5%), male circumcision (5%), and multicomponent (1%). Overall, 59% of interventions demonstrated efficacy in preventing infection with at least 1 STI. Treatment interventions and vaccines for viral STIs showed the most consistently positive effects. Male circumcision protected against viral STIs and possibly trichomoniasis. Almost two-thirds of behavioral interventions were effective, but the magnitude of effects ranged broadly. Partner services yielded similarly mixed results. In contrast, vaginal microbicides and physical barrier methods demonstrated few positive effects. Future STI prevention efforts should focus on enhancing adherence within interventions, integrating new technologies, ensuring sustainable behavior change, and conducting implementation research.
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Affiliation(s)
- Catherine M Wetmore
- Center for AIDS and STD and Department of Global Health, University of Washington, Box 358210, Suite 600, 2301 Fifth Avenue, Seattle, WA 98121, USA.
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Free C, Roberts IG, Abramsky T, Fitzgerald M, Wensley F. A systematic review of randomised controlled trials of interventions promoting effective condom use. J Epidemiol Community Health 2009; 65:100-10. [PMID: 19822557 PMCID: PMC3009845 DOI: 10.1136/jech.2008.085456] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Caroline Free
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Issues in the design, analysis and interpretation of condom functionality studies. Contraception 2009; 80:237-44. [DOI: 10.1016/j.contraception.2009.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/13/2009] [Indexed: 11/20/2022]
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Gallo MF, Steiner MJ, Warner L, Hylton-Kong T, Figueroa JP, Hobbs MM, Behets FM. Self-reported condom use is associated with reduced risk of chlamydia, gonorrhea, and trichomoniasis. Sex Transm Dis 2008; 34:829-33. [PMID: 17579339 DOI: 10.1097/olq.0b013e318073bd71] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the association between self-reported condom use and prevalent and incident chlamydia, gonorrhea, and trichomoniasis. STUDY DESIGN Prospective study of 414 males attending a sexually transmitted infection (STI) clinic in Jamaica. Condom use and STI status were assessed at enrollment and at 4 follow-up visits. RESULTS The analyses on condom use and prevalent STI included data from 414 men, while those on incident STI were based on 1111 intervals from 355 men. We diagnosed prevalent STI (chlamydia, gonorrhea, and/or trichomoniasis) in 54.6% (n = 226) of the participants at enrollment. About 14% (n = 51) of participants had at least 1 of the study STIs during follow-up. Follow-up visits in which participants reported consistent condom use (100% of acts) for the past 7 days had less incident STI (adjusted OR, 0.4; 95% CI, 0.2-0.9) compared with visits where no condom use was reported. Self-reported condom use was more closely correlated with incident than prevalent STI. For example, the adjusted OR for prevalent infection for participants reporting consistent versus no condom use in past 7 days was 0.7 (95% CI, 0.4-1.2). Classifications based on the number of unprotected acts yielded findings similar to those based on the proportion of acts protected. CONCLUSIONS Consistent condom use was associated with reduced risk of incident urethral STI. Research on condom effectiveness should focus on incident STI outcomes, where the temporal relationship between condom use and infection is clearer.
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Affiliation(s)
- Maria F Gallo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
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Guest G, Johnson L, Burke H, Rain-Taljaard R, Severy L, von Mollendorf C, Van Damme L. Changes in sexual behavior during a safety and feasibility trial of a microbicide/diaphragm combination: an integrated qualitative and quantitative analysis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:310-20. [PMID: 17685844 DOI: 10.1521/aeap.2007.19.4.310] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
If proven effective, vaginal microbicides and diaphragms will likely be part of a larger HIV prevention model that includes condoms and other prevention strategies. It is, therefore, important to understand how introducing new prevention methods may affect overall patterns of sexual risk behavior. Data presented were collected as part of a safety and feasibility study of ACIDFORM gel with a diaphragm among 120 women in South Africa. Interviews were administered at enrollment and months 1, 3, 5, and 6 of the trial. Focus groups were conducted at trial exit. Frequency of sex increased significantly after enrollment. This increase appears to be owing to perceived protection from HIV and greater sexual pleasure afforded by the gel. Male condom use was high overall but increased significantly from enrollment. Data suggest this is because of increased partner involvement, increased negotiating power afforded by study participation, and provision of free condoms perceived to be of high quality.
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Affiliation(s)
- Greg Guest
- Family Health International, Durham, NC 27713, USA.
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Steiner MJ, Taylor D, Hylton-Kong T, Mehta N, Figueroa JP, Bourne D, Hobbs M, Behets F. Decreased condom breakage and slippage rates after counseling men at a sexually transmitted infection clinic in Jamaica. Contraception 2007; 75:289-93. [PMID: 17362708 DOI: 10.1016/j.contraception.2006.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 12/05/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE Our objective was to evaluate condom failure (breakage and slippage) rates before and those during a trial that provided instructions on correct condom use. METHOD Our analysis was based on 314 men who presented with urethral discharge at Jamaica's largest sexually transmitted infection clinic and were enrolled into our 6-month trial. RESULTS Participants reported breaking 18.5% (95% confidence interval=12.8-24.1%) of their condoms during the 7 days prior to the screening visit and having 3.5% (95% confidence interval=1.2-5.7%) of their condoms slip off completely. After the condom counseling provided during the screening visit, breakage rates decreased (p<.05) and remained below 10% throughout the trial. During in-depth interviews, the men who reported frequent condom failures cited (1) improper storage/exposure to heat, (2) improper handling while putting on condoms and (3) use of lubricants/improper lubricants as the possible reasons for their high failure rates. CONCLUSION Although the rates of reported condom breakage and slippage decreased significantly after counseling, we need to improve the quality of condom counseling to further reduce failure rates.
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Affiliation(s)
- Markus J Steiner
- Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709, USA.
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Philpott A, Knerr W, Maher D. Promoting protection and pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy. Lancet 2006; 368:2028-31. [PMID: 17141710 DOI: 10.1016/s0140-6736(06)69810-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Anne Philpott
- Department for International Development, London, UK
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