Behavioral interventions for improving condom use for dual protection

Interventions promoting condom use for dual protection might not be effective for preventing pregnancy or sexually transmitted infections, although the evidence is insufficient.

Comment: The quality of evidence is downgraded by study quality (more than 20% loss to follow up in all trials and unclear allocation concealment in most of the studies) and by inconsistency (variability in results across studies).

Summary

A Cochrane review included 7 randomized controlled trials; 6 assigned clusters and 1 randomized individuals. Sample sizes for the cluster-randomized trials ranged from 2157 to 15 614; the number of clusters ranged from 18 to 70. 4 trials took place in African countries, 2 in the USA, and 1 in England. 3 were based mainly in schools, 2 were in community settings, 1 took place during military training, and 1 was clinic-based. No significant difference between study groups for pregnancy (3 trials) or HIV (4 trials) was shown. Favorable effects were evident for some sexually transmitted infections (STI): Two trials showed a lower incidence of HSV-2 for the behavioral-intervention group compared to the usual-care group, however a moderate quality trial showed no difference. For syphilis and gonorrhea, a moderate quality trial showed no difference, while two low quality studies had some favourable effects.

Another cochrane review review included 3 randomized controlled trials and a pilot study for one of the included trials. The interventions differed markedly: computer-delivered, individually tailored sessions; phone counseling added to clinic counseling; and case management plus a peer-leadership program. The latter study, which addressed multiple risks, showed an effect on contraceptive use. Compared to the control group, the intervention group was more likely to report consistent dual-method use, i.e., oral contraceptives and condoms. The reported relative risk was 1.58 at 12 months (95% CI 1.03 to 2.43) and 1.36 at 24 months (95% CI 1.01 to 1.85). The related pilot study showed more reporting of consistent dual-method use for the intervention group compared to the control group (P value = 0.06). The other two trials did not show any significant difference between the study groups in reported dual-method use or in test results for pregnancy or sexually transmitted infections at 12 or 24 months.

Clinical comments

Date of latest search: 5 March 2014

Ədəbiyyat

1. Lopez LM, Otterness C, Chen M et al. Behavioral interventions for improving condom use for dual protection. Cochrane Database Syst Rev 2013;(10):CD010662.
2. Lopez LM, Stockton LL, Chen M et al. Behavioral interventions for improving dual-method contraceptive use. Cochrane Database Syst Rev 2014;(3):CD010915.