Condom Social Marketing Effects in Low- and Middle-Income Countries: A Systematic Review Update, 1990 to 2019.

Objective: To update the prior systematic review from studies published in the past 9 years that examine the effects of condom social marketing (CSM) programs on condom use in low- and middle-income countries. Data Sources: PubMed, CINAHL, PsycINFO, Sociological Abstracts, and EMBASE. Hand searching of AIDS, AIDS and Behavior, AIDS Care, and AIDS Education and Prevention. Study Inclusion and Exclusion Criteria: (a) Published from 1990 to January 16, 2019, (b) low- or middle-income country, (c) evaluated CSM, (d) analyses across preintervention to postintervention exposure or across multiple study arms, (e) measured condom use behavior, and (f) sought to prevent HIV transmission. Data Extraction: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 reviewers extracted citation, inclusion criteria, methods, study population, setting, sampling, study design, unit of analysis, loss to follow-up, comparison group characteristics, intervention characteristics, and eligible outcome results. Data Synthesis: The 2012 review found 6 studies (combined N = 23 048). In a meta-analysis, the pooled odds ratio for condom use was 2.01 (95% confidence interval [CI]: 1.42-2.84) for the most recent sexual encounter and 2.10 (95% CI: 1.51-2.91) for a composite of all condom use outcomes. Studies had significant methodological limitations. Of 518 possible new citations identified in the update, no new articles met our inclusion criteria. Conclusions: More studies are needed with stronger methodological rigor to help provide evidence for the continued use of this approach globally. There is a dearth of studies over the past decade on the effectiveness of CSM in increasing condom use in low- and middle-income countries (LMIC).