A systematic review of randomised controlled trials of interventions promoting effective condom use.
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.
Free
Caroline
C
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. caroline.free@lshtm.ac.uk
Roberts
Ian G
IG
Abramsky
Tanya
T
Fitzgerald
Molly
M
Wensley
Frances
F
D017280:Condoms / Q000706:statistics & numerical data* / Q000600:supply & distribution; D016206:Databases, Bibliographic; D055317:Evidence-Based Practice; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods; D008297:Male; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012042:Registries; D015203:Reproducibility of Results; D012196:Review Literature as Topic; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D047568:Unsafe Sex / Q000706:statistics & numerical data