Effectiveness of the female condom in preventing HIV and sexually transmitted infections: a systematic review and meta-analysis

Ruth K. B. Mome,Phetole W. Mahasha,Charles S. Wiysonge,Eugene J. Kongnyuy,Alison B. Wiyeh

doi:10.1186/s12889-020-8384-7

Abstract

BackgroundThe 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.MethodsWe 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.ResultsWe 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.ConclusionThe 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.PROSPERO registration numberCRD42018090710

Highlights

The effectiveness of female condoms for preventing human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) remains inconclusive
It is estimated that 77·3 million people have been infected with HIV since the start of the HIV epidemic, with approximately half of those infected dying from AIDS related illnesses [1]
In subSaharan Africa, young women continue to lead in rates of new HIV infection with three in four new infections being amongst young girls aged 15–19 years [1, 2]

Summary

Introduction

The effectiveness of female condoms for preventing HIV and sexually transmitted infections (STIs) remains inconclusive. The subordinate status of women in many countries makes negotiating male condom use with partners especially difficult [9, 10]. This makes women vulnerable to HIV infection and other STIs like gonorrhoea, chlamydia, and syphilis. This warrants the need for alternative methods and effective female initiated methods for STI and HIV prevention

Objectives

Methods

Results

Discussion

Conclusion