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Study flow diagram.
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Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: the review authors' judgements about each risk of bias item presented as percentages across all the included studies.
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Figure 3

Risk of bias graph: the review authors' judgements about each risk of bias item presented as percentages across all the included studies.

Comparison 1 Comparison intervention versus control, Outcome 1 STI incidence for sex workers.
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Analysis 1.1

Comparison 1 Comparison intervention versus control, Outcome 1 STI incidence for sex workers.

Comparison 1 Comparison intervention versus control, Outcome 2 STI prevalence for clients of sex workers.
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Analysis 1.2

Comparison 1 Comparison intervention versus control, Outcome 2 STI prevalence for clients of sex workers.

Comparison 1 Comparison intervention versus control, Outcome 3 Condom use for sex workers.
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Analysis 1.3

Comparison 1 Comparison intervention versus control, Outcome 3 Condom use for sex workers.

Comparison 1 Comparison intervention versus control, Outcome 4 Condom use for clients of sex workers.
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Analysis 1.4

Comparison 1 Comparison intervention versus control, Outcome 4 Condom use for clients of sex workers.

Comparison 1 Comparison intervention versus control, Outcome 5 Knowledge of HIV transmission for sex workers.
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Analysis 1.5

Comparison 1 Comparison intervention versus control, Outcome 5 Knowledge of HIV transmission for sex workers.

Comparison 1 Comparison intervention versus control, Outcome 6 Knowledge of HIV transmission for clients of sex workers.
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Analysis 1.6

Comparison 1 Comparison intervention versus control, Outcome 6 Knowledge of HIV transmission for clients of sex workers.

Comparison 1 Comparison intervention versus control, Outcome 7 Visited female sex workers (for clients of sex workers).
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Analysis 1.7

Comparison 1 Comparison intervention versus control, Outcome 7 Visited female sex workers (for clients of sex workers).

Comparison 1 Comparison intervention versus control, Outcome 8 Perceiving very high efficacy of condom use for HIV prevention (For clients of sex workers).
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Analysis 1.8

Comparison 1 Comparison intervention versus control, Outcome 8 Perceiving very high efficacy of condom use for HIV prevention (For clients of sex workers).

Comparison 1 Comparison intervention versus control, Outcome 9 physical victimization for sex workers.
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Analysis 1.9

Comparison 1 Comparison intervention versus control, Outcome 9 physical victimization for sex workers.

Comparison 1 Comparison intervention versus control, Outcome 10 Sexual victimization for sex workers.
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Analysis 1.10

Comparison 1 Comparison intervention versus control, Outcome 10 Sexual victimization for sex workers.

Summary of findings for the main comparison. Behavioural intervention vs. control for reducing HIV transmission among sex workers and their clients in high‐income countries.

Behavioural intervention versus control for reducing HIV transmission among sex workers and their clients in high‐income countries.

Patient or population: Sex workers and their clients
Settings: High‐income countries
Intervention: Behavioural intervention versus control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Comparison intervention versus control

STI incidence for sex workers

Study population

RR 0.46
(0.11 to 1.98)

627
(2 studies)

⊕⊝⊝⊝
very low1,2,3,4

302 per 1000

139 per 1000
(33 to 598)

Moderate

268 per 1000

123 per 1000
(29 to 531)

STI prevalence for clients of sex workers

Study population

RR 0.09
(0.01 to 0.72)

288
(1 study)

⊕⊕⊕⊕
high3,5

75 per 1000

7 per 1000
(1 to 54)

Moderate

75 per 1000

7 per 1000
(1 to 54)

Condom use for sex workers

Study population

RR 1.04
(0.99 to 1.09)

1133
(3 studies)

⊕⊝⊝⊝
very low3,6

825 per 1000

858 per 1000
(817 to 900)

Moderate

729 per 1000

758 per 1000
(722 to 795)

Condom use for clients of sex workers

Study population

RR 1.1
(0.69 to 1.75)

26
(1 study)

⊕⊕⊕⊝
moderate3

706 per 1000

776 per 1000
(487 to 1000)

Moderate

706 per 1000

777 per 1000
(487 to 1000)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Not randomised studies.
2 Heterogeneity is significantly different.
3 Small sample size.
4 RR is 0.46.
5 RR is 0.09.
6 Including non randomised studies.

Figures and Tables -
Summary of findings for the main comparison. Behavioural intervention vs. control for reducing HIV transmission among sex workers and their clients in high‐income countries.
Comparison 1. Comparison intervention versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 STI incidence for sex workers Show forest plot

2

627

Risk Ratio (M‐H, Random, 95% CI)

0.46 [0.11, 1.98]

2 STI prevalence for clients of sex workers Show forest plot

1

288

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.01, 0.72]

3 Condom use for sex workers Show forest plot

3

1133

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.99, 1.09]

3.1 Randomised control trial

1

506

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.96, 1.03]

3.2 Quasi‐experimental pretest‐posttest with control group

2

627

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.99, 1.18]

4 Condom use for clients of sex workers Show forest plot

1

26

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.69, 1.75]

5 Knowledge of HIV transmission for sex workers Show forest plot

1

381

Risk Ratio (M‐H, Fixed, 95% CI)

1.82 [1.55, 2.14]

6 Knowledge of HIV transmission for clients of sex workers Show forest plot

1

287

Risk Ratio (M‐H, Fixed, 95% CI)

1.93 [1.46, 2.55]

7 Visited female sex workers (for clients of sex workers) Show forest plot

1

286

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.25, 1.18]

8 Perceiving very high efficacy of condom use for HIV prevention (For clients of sex workers) Show forest plot

1

287

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [0.89, 2.04]

9 physical victimization for sex workers Show forest plot

1

506

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.63, 1.56]

10 Sexual victimization for sex workers Show forest plot

1

506

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.53, 1.86]

Figures and Tables -
Comparison 1. Comparison intervention versus control