Behavioural interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis
Behavioural interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis
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DOI：
10.2471/blt.09.068213
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发表时间：
2010-08-01
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影响因子：
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通讯作者：
O'Reilly, Kevin R
中科院分区：
文献类型：
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作者：
Kennedy, Caitlin E;Medley, Amy M;O'Reilly, Kevin R
目的评价发展中国家艾滋病病毒(HIV)感染者和非感染者积极预防干预效果差异的证据，以及针对HIV感染者的干预措施的有效性。方法对1990年1月至2006年12月发表的有关发展中国家HIV感染者积极预防行为干预的文献进行系统回顾和荟萃分析。使用了标准化的搜索和数据提取方法。使用随机效应模型计算了汇集效应的大小。结果19项研究符合纳入标准。在Meta分析中，行为干预对HIV阳性者(OR：3.61；95%可信区间，CI：2.61-4.99)使用安全套的影响比HIV阴性者(OR：1.32；95%CI：0.77-2.26)更大。针对HIV+人群的干预措施对安全套的使用也显示出积极的效果(OR：7.84；95%CI：2.82-21.79)，尤其是在HIV血清不一致的夫妇中(OR：67.38；95%CI：36.17-125.52)。本次审查纳入的干预措施在范围(大多数是艾滋病毒咨询和检测干预措施)和目标人群(大多数是在异性恋成年人或艾滋病毒血清不一致的夫妇中进行)方面都有限。结论目前的证据表明，针对发展中国家艾滋病毒携带者的干预措施增加了避孕套的使用，特别是在艾滋病毒血清不一致的夫妇中。需要针对不同人群并涵盖一系列干预模式的全面积极预防干预措施，以保持艾滋病毒感染者的身心健康，防止艾滋病毒感染的传播，并增加艾滋病毒携带者的机构和参与。
Objective To assess the evidence for a differential effect of positive prevention interventions among individuals infected and not infected with human immunodeficiency virus (HIV) in developing countries, and to assess the effectiveness of interventions targeted specifically at people living with HIV.Methods We conducted a systematic review and meta-analysis of papers on positive prevention behavioural interventions in developing countries published between January 1990 and December 2006. Standardized methods of searching and data abstraction were used. Pooled effect sizes were calculated using random effects models.Findings Nineteen studies met the inclusion criteria. In meta-analysis, behavioural interventions had a stronger impact on condom use among HIV-positive (HIV+) individuals (odds ratio, OR: 3.61; 95% confidence interval, CI: 2.61-4.99) than among HIV-negative individuals (OR: 1.32; 95% CI: 0.77-2.26). Interventions specifically targeting HIV+ individuals also showed a positive effect on condom use (OR: 7.84; 95% CI: 2.82-21.79), which was particularly strong among HIV-serodiscordant couples (OR: 67.38; 95% CI: 36.17-125.52). Interventions included in this review were limited both in scope (most were HIV counselling and testing interventions) and in target populations (most were conducted among heterosexual adults or HIV-serodiscordant couples).Conclusion Current evidence suggests that interventions targeting people living with HIV in developing countries increase condom use, especially among HIV-serodiscordant couples. Comprehensive positive prevention interventions targeting diverse populations and covering a range of intervention modalities are needed to keep HIV+ individuals physically and mentally healthy, prevent transmission of HIV infection and increase the agency and involvement of people living with HIV.