Synthesizing HIV Behavioral Intervention Effectiveness in Developing Countries

描述(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)干预效果的证据基础不断变化和迅速增长，以及(3)缺乏干预方法的共同标准和术语。人们对针对结构和社会生态层面因素的有前途的干预方法也越来越感兴趣，但对于什么是“结构性干预”，在理论上几乎没有共同的理解。此外，发表在同行评议文献中的许多科学研究使用了干预方法的通用术语，但实施计划的方式往往截然不同。在这项拟议的研究中，我们将系统地审查和荟萃分析15项关键的艾滋病毒行为干预措施的影响，并对我们以前所做的12项额外干预措施进行系统审查和荟萃分析的最新情况。此外，将针对上述干预专题启动干预案例研究，在这些专题中，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。将综合的干预措施包括：(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)人际技能培训(赋权)，(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)建筑环境、(10)政策干预、(11)增强社会资本、(12)社区动员、(13)加强坚持抗逆转录病毒治疗(ART)的干预措施、(14)旨在增加艾滋病治疗、母婴传播方案和艾滋病毒检测的干预措施，以及(15)促进血清滴注的干预措施、(16)阳性预防、(17)艾滋病毒自愿咨询和检测(VCT)、(18)同伴教育、(19)艾滋病毒感染妇女的计划生育咨询，(20)避孕套社会营销，(21)大众媒体，(22)性伴侣通知，(23)禁欲干预，(24)针头和注射器方案(NSP)，(25)心理社会支持，(26)关爱作为预防，和(27)以学校为基础的全面性教育。

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.