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A Systematic Review of Randomised Controlled Trials of Interventions Promoting Effective Condom Use
  1. Caroline Free1,*,
  2. Roberts Ian1,
  3. Tanya Abramsky1,
  4. Molly Fitzgerald1,
  5. Frances Wensley2
  1. 1 LSHTM, United Kingdom;
  2. 2 Cambridge, United Kingdom
  1. Correspondence to: Caroline Free, Epidemiology and population studies, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom;{at}


Background: Effective condom use can prevent sexually transmitted infections and unwanted pregnancy. We conducted a systematic review and methodological appraisal of randomised controlled trials of interventions to promote effective condom use.

Methods: We searched for all randomised controlled trials 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), 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 5 statistically significant results. Three out of 4 trials reported reductions in pregnancy, although none was statistically significant. Only four trials met all the quality criteria. Trials reported a median of 11 (IQR7-17) outcome measures. Few trials used the same outcome measure. Ten trials (7%) used the outcome ‘any STI’, four (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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