The Efficacy and Safety of Topical Microbicide Gels to Prevent Sexual Transmission of Human Immunodeficiency Virus (HIV) Infection: a Systematic Review and Meta-analysis
Bibliographic record
Abstract
Abstract Background: Topical microbicide gels are a potential method to reduce sexually transmitted human immunodeficiency virus (HIV) infection, especially in women. Several randomized controlled trials (RCTs) of topical microbicides to prevent HIV transmission have yielded promising results, however trial results have been inconsistent. The objective of this study was to determine the efficacy and safety of topical microbicide gels to prevent HIV transmission.Methods: We conducted meta-analyses, stratified by microbicide gel type, using a random-effects model. We included 25 RCTs that met the inclusion criteria: 13 RCTs examined gel efficacy during heterosexual contact, and an additional 12 trials reported on gel acceptability, participants’ adherence to intervention, and adverse reactions (allergic reaction and pain). Results: With this limited data, topical microbicide gels were not found to be significantly better than placebo in preventing HIV infection (risk ratio (RR) 0.93, 95% CI 0.82 to 1.04; I2 14%; 13 trials; 31,764 participants). It should be noted that low adherence rates were frequently reported within trials. In one trial with high participant adherence (>70%) to intervention, there was a significant protective effect of gels (RR 0.63, 95% CI 0.43 to 0.93; 889 participants). While measures of acceptability and adherence to intervention were similar between groups, administration of topical microbicides were associated with an increased incidence of pain at the application site (RR 1.16, 95% CI 1.00 to 1.36, I2 0%, 15 trials, 19,554 participants).Conclusions: In conclusion, efficacy of topical microbicide gels may relate to baseline risk and compliance with the intervention. In the general population it is not associated with protection from sexually transmitted HIV infection.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.039 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".