Synthesizing HIV Behavioral Intervention Effectiveness in Developing Countries

描述（由申请人提供）：在发展中国家制定全面的艾滋病毒预防计划面临多重挑战，包括：(1)对干预措施的相对有效性普遍缺乏共识，(2)对干预效果的证据基础不断变化和快速增长，以及(3)缺乏共同的标准和术语。人们对以结构和社会生态水平因素为目标的有希望的干预方法也越来越感兴趣，然而，对于什么是“结构性干预”，几乎没有共同的理论理解。同样，在同行评议文献中发表的许多科学研究使用共同的术语来描述干预方法，但通常实施的方案非常不同。在这项拟议的研究中，我们将系统地回顾和荟萃分析15项关键的艾滋病毒行为干预措施的影响，并对我们之前所做的12项额外干预措施进行系统回顾和荟萃分析。此外，将针对上述干预主题开展干预案例研究，其中有证据表明调查人员在如何定义和实施干预方面缺乏一致性。综合干预措施包括：(1)提供者发起的艾滋病毒检测和咨询（PITC），(2)药物治疗，(3)家庭生活教育，(4)人际关系技能培训（授权），(5)行为咨询，(6)传播和意见领袖，(7)免费发放避孕套；(8)创收，(9)建成环境，（10）政策干预，（11）社会资本增加，（12）社区动员，（13）加强抗逆转录病毒治疗（ART）依从性的干预措施，（14）旨在增加艾滋病治疗、母婴传播（MTCT）项目和艾滋病毒检测的干预措施，以及（15）促进血清分类的干预措施，（16）积极预防，（17）艾滋病毒自愿咨询和检测（VCT），（18）同伴教育，（19）为感染艾滋病毒的妇女提供计划生育咨询，（20）避孕套社会营销，（21）大众媒体，（22）伴侣通知，（23）基于禁欲的干预，（24）针头和注射器计划（NSP），（25）社会心理支持，（26）护理预防，以及（27）以学校为基础的综合性教育。

DESCRIPTION (provided by applicant): There are multiple challenges to developing comprehensive HIV prevention programs in developing countries, including: (1) a general lack of consensus on the relative efficacy of interventions, (2) an ever changing and rapidly growing evidence base on intervention efficacy, and (3) a lack of shared standards and terminology for intervention approaches. There has also been a growing interest in promising intervention approaches that target structural and socio-ecological level factors, yet there is little shared theoretical understanding of what constitutes a "structural intervention". As well, many scientific studies published in the peer reviewed literature use common terms for intervention approaches, yet often implement programs very differently. In this proposed study we will systematically review and meta-analyze the impact of 15 key HIV behavioral interventions, and conduct updates on systematic reviews and meta-analyses on 12 additional interventions we have done previously. In addition, intervention case studies will be initiated for those intervention topics listed above in which there is evidence of a lack of consistency across investigators in how they are defining and implementing the intervention. The interventions to be synthesized include: (1) Provider-Initiated HIV Testing and Counseling (PITC), (2) Drug Treatment, (3) Family Life Education, (4) Interpersonal Skills Training (Empowerment), (5) Behavioral Counseling, and (6) Diffusion & Opinion Leader, (7) Free Condom Distribution; (8) Income Generation, (9) Built Environment, (10) Policy Interventions, (11) Social Capital Enhancement, (12) Community Mobilization, (13) Interventions to Enhance Adherence to Antiretroviral Treatment (ART), (14) Interventions designed to Increase Uptake of AIDS Treatment, Mother to Child Transmission (MTCT) Programs, and HIV Testing, and (15) Interventions that Promote Serosorting, (16) Positive Prevention, (17) HIV Voluntary Counseling and Testing (VCT), (18) Peer Education , (19) Family Planning Counseling for HIV-infected Women, (20) Condom Social Marketing, (21) Mass Media, (22) Partner Notification, (23) Abstinence-based Interventions, (24) Needle and Syringe Programs (NSP), (25) Psychosocial Support, (26) Care as Prevention, and (27) Comprehensive School-based Sex Education. PUBLIC HEALTH RELEVANCE: With the dramatic growth in funding for HIV behavioral interventions in developing countries there are multiple initiatives to better allocate of these funds based on evidenced-based standards. Comparative effectiveness studies have been requested by multiple donors and agencies to meet this need. This requires up to date systematic reviews and meta-analyses, as well as careful evaluation of the content of interventions. These will result in improved understanding of which intervention components are proven to be most efficacious, and will advance the field in establishing clear intervention terminology and theoretical constructs. The goal of this study is to provide needed policy and program advice on what is working in HIV prevention based on the strength of evidence from the scientific literature.