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Effective evidence-based HIV prevention strategies are urgently needed, but the “gold standard” randomized controlled trial (RCT) alone might not be the best way to identify those strategies.
To explore this issue, researchers conducted a systematic review of 37 RCTs of interventions aimed at preventing sexual transmission of HIV. The trials included nearly 160,000 individuals and involved 39 unique interventions, including behavior modification, diaphragms, microbicides, preexposure prophylaxis, male circumcision, vaccines, and treatment for sexually transmitted infections (STIs).
Thirty-one of the RCTs produced what the authors call “flat” results, meaning they did not show any effect, positive or negative, on HIV transmission. Five trials …