HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis
HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis
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DOI：
10.1016/s1473-3099(10)70189-4
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发表时间：
2010-11-01
影响因子：
56.3
通讯作者：
Mills, Edward J.
中科院分区：
文献类型：
--
作者：
Eyawo, Oghenowede;de Walque, Damien;Mills, Edward J.
在撒哈拉以南非洲，大多数受艾滋病毒/艾滋病影响的夫妇生活在不和谐的关系中。男人被认为是大多数关系中的指标案例，大多数社会营销和宣传活动都集中在男人身上。我们调查血清不一致稳定的关系，以建立性别平衡的索引病例infecties.Methods，我们做了一个系统的回顾，随机效应荟萃分析，荟萃回归的已发表和未发表的研究招募不一致的夫妇和评估的比例，男性和女性的索引情况。我们对来自14个国家的人口与健康调查（DHS）数据进行了重复分析，这些国家记录了夫妇的艾滋病毒状况。我们的主要成果是艾滋病毒不和谐的夫妇，包括艾滋病毒阳性women.Findings的比例的总数，我们包括从27个队列的13061对夫妇和DHS数据从14个国家的1145对夫妇。在稳定的异性血清不一致关系中，艾滋病毒阳性妇女的比例为47%（95% CI 43-52），这表明妇女和男子一样可能成为不一致夫妇的指数伴侣。DHS数据（46%，41-51）和我们的敏感性分析（47%，43-52）显示了类似的结果。元回归显示，城市与农村居住（比值比0.31，95% CI 0.22-0.39），纬度（β系数0.02，0.023-0.034），两性平等（β系数-0.42，-0.56至-0.27），艾滋病毒流行率（β系数-0-037，-0.04至-0.030），以及年龄较大（β系数0.20，0.08-0.32）与女性指数病例的比例相关。解释我们的研究表明，在艾滋病毒预防战略中需要关注两性，例如推广使用避孕套和减少危险行为。
Background Most couples affected by HIV/AIDS in sub-Saharan Africa live in discordant relationships. Men are thought to be the index case in most relationships, and most social marketing and awareness campaigns are focused on men. We investigated serodiscordance in stable relationships to establish the gender balance of index-case infections.Methods We did a systematic review, random-effects meta-analysis, and meta-regression of published and unpublished studies enrolling discordant couples and assessed the proportion of men and women that were index cases. We repeated the analysis with data from demographic and health surveys (DHS) from the 14 countries that have documented the HIV status of couples. Our primary outcome was the total number of HIV discordant couples, including the proportion of HIV-positive women.Findings We included data from 27 cohorts of 13 061 couples and DHS data from 14 countries of 1145 couples. The proportion of HIV-positive women in stable heterosexual serodiscordant relationships was 47% (95% CI 43-52), which shows that women are as likely as men to be the index partner in a discordant couple. DHS data (46%, 41-51) and our sensitivity analysis (47%, 43-52) showed similar findings. Meta-regression showed that urban versus rural residence (odds ratio 0.31, 95% CI 0.22-0.39), latitude (beta coefficient 0.02, 0.023-0.034), gender equality (beta coefficient -0.42, -0.56 to -0.27), HIV prevalence (beta coefficient -0-037, -0.04 to -0.030), and older age (beta coefficient 0.20, 0.08-0.32) were associated with the proportion of female index cases.Interpretation Our study shows the need to focus on both sexes in HIV prevention strategies, such as promotion of condom use and mitigation of risk behaviours.