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      Effectiveness of female condom in preventing HIV and sexually transmitted infections: a systematic review protocol

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          Abstract

          Introduction

          The HIV pandemic continues to evolve with young women being the most vulnerable group to acquire infection. The presence of sexually transmitted infections (STIs) further enhances HIV susceptibility and also leads to long-term complications such as infertility and cervical cancer. The female condom is a self-initiated method for STI and HIV prevention but there are controversies on its effects. We aim to assess the effectiveness, safety and acceptability of the use of female condoms for prevention of STI and HIV acquisition among women.

          Methods and analysis

          We will search Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Scopus, WHO International Clinical Trials Registry and reference lists of relevant publications for potentially eligible studies. We will screen search outputs, select eligible studies, extract data and assess risk of bias in duplicate; resolving discrepancies through discussion and consensus or arbitration. We will combine data from clinically homogenous studies in a fixed effect meta-analysis and assess the certainty of the evidence using the method for Grading of Recommendations Assessment, Development and Evaluation. We registered the planned systematic review with the International Prospective Register of Systematic Reviews (PROSPERO) in March 2018 and will finalise the search strategy in August 2018; conduct the searches and select eligible studies between August and October 2018; and collect data, conduct statistical analyses and prepare and submit the manuscript for consideration by a peer-reviewed journal between November 2018 and April 2019.

          Ethics and dissemination

          We will use publicly available data; hence no formal ethical approval is required for this review. We will disseminate the findings of this review through conference presentations and publication in an open-access peer-reviewed journal.

          PROSPERO registration number

          CRD42018090710.

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          Most cited references18

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          Contribution of sexually transmitted infections to the sexual transmission of HIV.

          Helen Ward, Minttu Rönn (2010)
          We review recent evidence about the link between sexually transmitted infections (STI) and HIV transmission and consider implications for control programmes. New studies and meta-analyses confirm the association of HIV acquisition and transmission with recent STIs, although there is considerable heterogeneity between organisms and populations. Much of the recent evidence relates to herpes simplex virus type 2 (HSV-2), for which the population-attributable risk percentage (PAR%) for HSV-2 is between 25 and 35 in Africa. Mathematical models show how transmission attributable to STI varies with HIV epidemic phase, and HSV-2 becomes increasingly important as the epidemic matures. HSV-2 suppressive therapy reduces HIV concentrations in plasma and the genital tract in people coinfected with HSV-2, in part due to direct inhibition of HIV reverse transcriptase. Recent trials of HSV-2 suppressive therapy have not shown an impact on the risk of HIV acquisition, nor in controlling transmission from dually infected people to their serodiscordant heterosexual partners. Although there is a plausible link between STI and HIV risk, intervention studies continue to be disappointing. This fact does not disprove a causal link, but mechanisms of action and the design and implementation of interventions need to be better understood.
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            Condom effectiveness in reducing heterosexual HIV transmission: a systematic review and meta-analysis of studies on HIV serodiscordant couples.

            Michael A Talias, Georgios Nikolopoulos, Chrissa G Tsiara … (2016)
            This systematic review and meta-analysis aimed to reassess the effectiveness of condoms in reducing heterosexual transmission of HIV.
            Article 0 comments Cited 30 times – based on 0 reviews     Review now
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              Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South Africa

              Sphiwe Madiba, Nomsa Ngwenya (2017)
              ABSTRACT Background: Women in sub-Saharan Africa bear the brunt of the human immunodeficiency virus (HIV) epidemic, and older married women and those in cohabiting relationships are regarded as the largest HIV risk group. Although preventing HIV infection in married or stable relationships is an international HIV prevention priority, little is known about the influence of sociocultural contexts on safe-sex practice by women, particularly older women in rural communities in South Africa. Objectives: This study aimed to examine how older women in a rural patriarchal society negotiate safer sex within marital and long-term cohabitation relationships, and their perceptions and experiences of barriers that influence condom use. Methods: Focus group discussions were conducted with married and cohabiting women aged 40–60 years recruited from primary health facilities in a rural district in Mpumalanga province, South Africa. A thematic analysis approach was used to analyse the data. Results: We found that although women reported negotiating safe sex in their relationships, they dreaded the possible consequences of suggesting condom use with their partners. Many factors made negotiating safe sex complex for these women: living in a patriarchal society where women play no part in sexual decision making, the fear of possible consequences of insisting on condom use, women’s inferior social position in marital relationships, cultural practices such as bride price, and gender inequality were the main barriers to practising safer sex. Conclusions: Older married and cohabiting women dreaded negotiating safer sex in this patriarchal society where women’s subordination is legitimized. The findings suggest that the women were at high risk of HIV infection because of their inability to negotiate condom use, or to reject forced sex and non-consensual sex. There is a need for interventions targeting older married and cohabiting couples and key stakeholders within communities to create awareness about cultural practices and beliefs that undermine women and HIV prevention efforts.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2018
                Publication date (Electronic): 5 August 2018
                Volume: 8
                Issue: 8
                Electronic Location Identifier: e023055
                Affiliations
                [1 ] departmentDepartment of Internal Medicine , Ottumwa Regional Health Center , Ottumwa, Iowa, USA
                [2 ] departmentCochrane South Africa , South African Medical Research Council , Cape Town, Western Cape, South Africa
                [3 ] departmentSchool of Global Health and Bioethics , Euclid University , Banjul, Gambia
                [4 ] departmentDivision of Epidemiology and Biostatistics, Department of Global Health , Stellenbosch University , Cape Town, South Africa
                [5 ] departmentDivision of Epidemiology and Biostatistics, School of Public Health and Family Medicine , University of Cape Town , Cape Town, South Africa
                Author notes
                [Correspondence to ] Dr Alison B Wiyeh; wberiliy@ 123456yahoo.co.uk
                Article
                Publisher ID: bmjopen-2018-023055
                DOI: 10.1136/bmjopen-2018-023055
                PMC ID: 6078242
                PubMed ID: 30082362
                SO-VID: f7bcb1c1-7667-4da7-ab8a-9a00c86f6fa6
                Copyright © © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 19 March 2018
                Date revision received : 29 May 2018
                Date accepted : 29 June 2018
                Funding
                Funded by: National Research Foundation of South Africa;
                Funded by: FundRef http://dx.doi.org/10.13039/501100001322, South African Medical Research Council;
                Categories
                Subject: HIV/AIDS
                Subject: Protocol
                Subject: 1506
                Subject: 1865
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: female condom,sexually transmitted infections
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: female condom, sexually transmitted infections

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