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    Effectiveness of vaginal microbicides in preventing HIV transmission

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    Author
    Musekiwa, A.
    Fernando, N.B.
    Abariga, S.A.
    Date
    2020
    Journal
    Tropical Medicine and International Health
    Publisher
    Blackwell Publishing Ltd
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1111/tmi.13401
    Abstract
    Objective: To evaluate the evidence on the effectiveness of vaginal microbicides in preventing HIV transmission in women. Methods: Systematic review through a comprehensive search of relevant electronic databases for eligible randomised controlled trials (RCTs) published through June 2019. Two authors independently screened titles and abstracts according to eligibility criteria, then extracted data and assessed risk of bias of included studies. We conducted a random-effects meta-analysis of risk ratios (RR) of HIV infection and assessed heterogeneity using chi-squared and I2 tests. Sources of heterogeneity were investigated through subgroup analysis, publication bias was assessed using funnel plots, and certainty of evidence was graded using GRADEPro software. Results: We included 18 RCTs which enrolled 40,048 sexually active, HIV-negative, non-pregnant women, aged 16 years and older, mainly from sub-Saharan Africa. The intravaginal ring containing dapivirine significantly reduced HIV risk by 29% (RR 0.71, 95% CI: 0.57-0.89; 2 RCTs, 4,564 women, moderate certainty of evidence). Estimates of effect of tenofovir 1% (RR 0.83, 95% CI: 0.65-1.06), nonoxynol-9 (RR 1.15, 95% CI: 0.93-1.42), cellulose sulphate (RR 1.16, 95% CI: 0.61-2.21), SAVVY (RR 1.34, 95% CI: 0.69-2.59), Carraguard (RR 0.89, 95% CI: 0.71-1.10), BufferGel (RR 1.02, 95% CI: 0.71-1.46), 0.5% PRO2000 (RR 0.88, 95% CI: 0.60-1.28) and 2% PRO2000 (RR 0.81, 95% CI: 0.58-1.12) failed to reach statistical significance; each had low certainty of evidence. Conclusion: The long-acting intravaginal ring containing dapivirine significantly reduced risk of HIV transmission in women by 29%. The remaining microbicides had no evident effect.
    Keyword
    dapivirinery
    HIV prevention
    meta-analysis
    systematic review
    vaginal microbicide
    vaginal ring
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85084487071&doi=10.1111%2ftmi.13401&partnerID=40&md5=9bd66d202f51f5306f2d5f474052eb23; http://hdl.handle.net/10713/12809
    ae974a485f413a2113503eed53cd6c53
    10.1111/tmi.13401
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    UMB Open Access Articles 2020

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