In a systematic review and meta-analysis, Kazem Rahimi and colleagues examine the burden of heart failure in low- and middle-income countries. Please see later in the article for the Editors' Summary

As microbicide development continues and the first investigational products move into efficacy trials, the needs and preferences of those women who constitute the potential users of microbicides become paramount. Providing woman-initiated microbicides that are safe, easy to use, and pleasurable will be key to the impact these products will have on the AIDS epidemic worldwide.

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BackgroundSetting priorities for the prevention and management of heart failure requires an empirical understanding of the pattern of disease burden. We aim to describe the methods for a systematic review of the literature on burden of heart failure in low- and middle-income countries (LMIC) and how this information will be synthesized to produce useful estimates that can inform policy and practice.MethodsWe will conduct a comprehensive search strategy for articles published between 1995 and April 2012 related to incidence, prevalence and treatment of heart failure in LMIC. Populations will be coded as urban, rural, or combined and studies classified as national, sub-national, healthcare system-based, or community level. Details from eligible studies will be extracted independently by two reviewers using a pre-designed data extraction form that will cover information on demographics, diagnostic criteria including disease incidence and prevalence, medical history, medication history, and hospital- or community-based management and outcomes. We will assess the reporting and methodological quality of the included studies and conduct a quantitative summary of reported outcomes where appropriate.DiscussionCurrently, there are important gaps in our knowledge on the burden of heart failure in LMIC and this systematic review aims to provide useful information that improves our knowledge in this field. Results are expected to be publicly available in early 2013.

Advantage-S, a spermicide containing nonoxynol-9 (N-9), has recently been shown in a randomised, controlled trial sponsored by UNAIDS not to offer women protection against sexual transmission of HIV. The women in the trial, all sex workers, reported having an average of 3.6 partners per day and about 70 coital acts per month during the study period. At the end of the trial, the Advantage-S group was found to have a higher incidence of new HIV infections than the control group, who were using a vaginal lubricant. Two other recent studies have found that low dose N-9 products do not provide protection against bacterial STDs such as gonorrhoea and chlamydia--a finding that contradicts earlier wisdom based on less rigorous studies. Contrary to certain media headlines, however, the results of these trials do not suggest that effective microbicides cannot be developed, only that Advantage-S, which was developed as a spermicide and not as a microbicide, is probably not one of them. The failure of Advantage-S to show protection in the UNAIDS-sponsored trial underscores the urgent need to accelerate research to develop a safe and effective topical microbicide.

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