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Effectiveness of vaginal microbicides in preventing HIV transmission
Author(s) -
Musekiwa Alfred,
Fernando Nimasha B.,
Abariga Samuel A.
Publication year - 2020
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13401
Subject(s) - medicine , relative risk , vaginal microbicide , microbicides for sexually transmitted diseases , meta analysis , gynecology , obstetrics , human immunodeficiency virus (hiv) , randomized controlled trial , statistical significance , confidence interval , population , immunology , environmental health , health services
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 I 2 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.