Effectiveness of interventions for changing HIV related risk behaviours among key populations in low-income setting: A Meta-Analysis, 2001-2016
Effectiveness of interventions for changing HIV related risk behaviours among key populations in low-income setting: A Meta-Analysis, 2001-2016
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DOI：
10.1038/s41598-020-58767-0
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发表时间：
2020-02-10
影响因子：
4.6
通讯作者：
Ekstrom, Anna Mia
中科院分区：
文献类型：
--
作者：
Deuba, Keshab;Sapkota, Diksha;Ekstrom, Anna Mia
这次审查的目的是进行一项元分析，以评估过去二十年来行为干预措施在尼泊尔减少注射吸毒者、女性性工作者、男男性行为者和变性人等关键人群中与艾滋病毒有关的风险行为的有效性。使用四个电子数据库，我们对2001年1月至2016年12月在尼泊尔实施的艾滋病毒干预措施的文献进行了系统检索。此外，还审查了灰色文献中的潜在文章。搜索工作特别侧重于针对关键人群的行为干预措施（同伴教育和艾滋病毒检测服务）。随机效应模型用于计算二分结果（最后一次性行为中使用避孕套或不安全注射做法）的合并比值比，合并艾滋病毒流行率和尼泊尔年龄组和流行区的亚组分析。纳入了43项研究，共有15，642名参与者（注射毒品者：7，105人;男男性行为者和变性人：2，637人;女性性工作者：5，900人）。合并流行率显示，注射吸毒者艾滋病毒感染率较高（12%），其次分别是男男性行为者/变性者（5%）和女性性工作者（2%）。在女性性工作者、男男性行为者和变性者中，与没有接受非正式和正式环境同伴教育干预的人相比，使用安全套的几率显著增加。同样，接受艾滋病毒咨询和检测服务的女性性工作者、男男性行为者和变性者使用安全套的几率比未使用此类服务的人大幅度提高。分组分析还证实了这些干预措施对年轻和成年重点人群以及所有三个流行区的有效性。然而，没有一项干预措施被认为对减少注射吸毒者中的不安全注射做法有效。在过去二十年中，尼泊尔的艾滋病毒预防干预措施有效地减少了女性性工作者、男男性行为者和变性者的危险行为，但注射毒品者的危险行为却没有减少。这就要求继续开展现有努力，并采取适应注射吸毒者需要的新干预措施。
The aim of this review was to conduct a meta-analysis to assess the effectiveness of behavioural interventions to reduce HIV-related risk behaviours among key populations: people who inject drugs, female sex workers, men who have sex with men and transgender in Nepal over the last two decades. Using four electronic databases, we performed a systematic search of the literature on HIV interventions implemented in Nepal and published from January 2001 to December 2016. In addition, grey literature was also scrutinised for potential articles. The search focussed specifically on behavioural interventions (peer education and HIV testing services) targeted for key populations. Random-effects models were used to calculate the pooled odds ratio for dichotomous outcomes (condom use in last sex or unsafe injection practices), pooled HIV prevalence and subgroup analyses by age groups and epidemic zones in Nepal. Forty-three studies with 15,642 participants were included (people who inject drugs: 7105; men who have sex with men and transgender: 2637; female sex workers: 5900). Pooled prevalence showed a higher occurrence of HIV among people who inject drugs (12%) followed by men who have sex with men/transgender (5%) and female sex workers (2%) respectively. There was a significant increase in the odds of condom use among female sex workers, men who have sex with men and transgender who received peer education interventions in both informal and formal setting compared to those who did not. Similarly, the odds of condom use among female sex workers, men who have sex with men and transgender improved significantly among those who received HIV counselling and testing services as compared to those who did not use such services. Subgroup analyses also verified the effectiveness of these interventions for both young and adult key populations and across all three epidemic zones. However, none of the included interventions were found to be effective for reducing unsafe injection practices among people who inject drugs. HIV prevention interventions in Nepal have effectively reduced risky behaviours among female sex workers, men who have sex with men and transgender over the last two decades but not among people who inject drugs. This calls for continued implementation of existing efforts as well as for new interventions adapted to the needs of people who inject drugs.