Synthesizing HIV Behavioral Intervention Effectiveness in Developing Countries

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 DESCRIPTION (provided by applicant): Among the estimated 35.3 million people living with HIV and AIDS the vast majority reside in low- and middle- income countries. The capacity for mounting prevention and care for HIV in these settings in recent years has become strained, with ever increasing demand for services coupled with neutral or reduced levels of funding. This is putting enormous pressure on HIV prevention and care programs to spend these limited funds wisely and efficiently through use of evidence-based guidance. Despite the vast and ever growing scientific literature on the efficacy of interventions, interpreting the scientific literatre is challenging since identifying relevant studies is time intensive; the quality of research from published reports requires careful analysis; there are conflicting findings across studies; metrics and study designs used across studies are typically inconsistent; and pooling results across studies requires advanced statistical techniques. The state of the art strategy to address these challenges is to use systematic reviews and meta-analyses to analyze and interpret the effects of interventions evidenced with research across multiple studies. In this renewal of our current project we will conduct systematic reviews and meta-analyses on 20 key behavioral interventions on HIV HIV-related outcomes conducted in low/middle-income countries. Cultural and contextual factors will be assessed with the input from collaborators from low- and middle- income country colleagues. We will also now expand our strategy to incorporate behavioral interventions linked biomedical interventions based on their emergence and widespread implementation, and the critical role human behavior plays in the success of biomedical strategies. In addition, the study will now also give critical attention to co-occurring (Multivalet / Combination) interventions across the large array of studies examined, and will conduct stratified meta-analyses, meta- regression, and network meta-analyses to identify how co-intervention affects the strength of intervention outcomes. The outcomes of the study, especially with regard to missing systematic reviews on behavioral interventions linked to biomedical programs and combination prevention, will enable enhanced mathematical modeling of population-level impacts.