WEAC0104 - Oral Abstract
Is use of antiretroviral treatment (ART) associated with decreased condom use? A meta-analysis of studies from low- and middle-income countries (LMICs)
Presented by Caitlin Kennedy (United States).
C. Kennedy1, K. Armstrong2, V. Fonner1, M. Sweat2, K. O'Reilly2
1Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, United States, 2Medical University of South Carolina, Psychiatry and Behavioral Sciences, Charleston, United States
rapidly expanding ART access in LMICs, concerns remain about increases in risky
sexual behavior due to treatment optimism, physical health improvements, and
assumptions of non-infectiousness with low/undetectable viral load. Conversely,
ART may be associated with less risky behavior due to reduced depression,
increased hope, and regular medical contact. Research from high-income
countries has shown no association between ART and unsafe sex, but despite a
rapidly expanding evidence base, no published meta-analyses have examined this
issue in LMICs. We conducted a meta-analysis of the association between ART and
condom use among PLHIV in LMICs.
PRISMA guidelines, we systematically reviewed and meta-analyzed data from
peer-reviewed journal articles from 1/1/1990-5/9/2012. Articles were identified
through a comprehensive search of electronic databases, hand searching of key
journals, and secondary reference screening. Studies were included if they
presented pre-post or multi-arm measures of ART and sexual behavior in LMICs.
Two trained coders independently abstracted data using standardized forms. Meta-analysis
was conducted using random effects models, stratifying by gender and partner
Results: Of 6646
initial citations, 37 studies met the inclusion criteria. Studies came
primarily from sub-Saharan Africa (N=30), with additional studies from Thailand
(N=4), Brazil (N=2), and India (N=1). Most
used cross-sectional or prospective cohort designs, although there were two
retrospective cohorts and one non-randomized controlled study. In meta-analysis,
PLHIV on ART were more likely to report consistent condom use (Odds ratio [OR]: 1.8,
95% confidence interval [CI]:1.4-2.5, p< 0.000, I2=65.4%) and
condom use at last sex (OR:2.3, 95% CI: 1.5-3.6, P< 0.000, I2=88.6%)
than those not on ART. This finding was strikingly consistent across
sub-analyses by gender and partner type (OR range:1.4-2.6), although not always statistically
significant. The strongest effects were seen in consistent condom use with
HIV-/unknown status partners (OR:2.6, 95% CI:1.8-3.7, p< 0.000) and spouses
(OR:2.6, 95% CI:1.2-5.7, p=0.013). Heterogeneity across analyses was high.
results show that in LMIC, PLHIV on ART are more likely to report condom use
than those not on ART. This is encouraging news for continued expansion of ART
programs in LMICs and suggests that “treatment as prevention” may be true in
more ways than one.
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