Synthesizing HIV Behavioral Intervention Effectiveness in Developing Countries

 说明(申请人提供)：在约3530万艾滋病毒/艾滋病感染者中，绝大多数人居住在低收入和中等收入国家。近年来，在这些环境中加强艾滋病毒预防和护理的能力变得紧张，对服务的需求不断增加，同时资金水平中性或减少。这给艾滋病毒预防和护理项目带来了巨大的压力，要求他们通过使用循证指导，明智和有效地使用这些有限的资金。尽管关于干预效果的科学文献很多，而且还在不断增加，但解释科学文献是具有挑战性的，因为确定相关研究是耗时的；从已发表的报告中进行研究的质量需要仔细分析；各研究之间存在相互矛盾的发现；度量 跨研究使用的研究设计通常是不一致的；跨研究合并结果需要先进的统计技术。应对这些挑战的最新战略是使用系统回顾和荟萃分析来分析和解释通过多项研究的研究证明的干预措施的效果。在我们当前项目的更新中，我们将对在低收入/中等收入国家进行的关于艾滋病毒相关结果的20项关键行为干预措施进行系统审查和荟萃分析。将根据来自中低收入国家同事的合作者的意见对文化和背景因素进行评估。我们现在还将扩展我们的战略，将基于生物医学干预的出现和广泛实施的行为干预与生物医学干预相联系，以及人类行为在生物医学战略成功中发挥的关键作用。此外，这项研究现在还将在所审查的大量研究中对共同发生的(多代/组合)干预给予关键关注，并将进行分层元分析、元回归和网络元分析，以确定共同干预如何影响干预结果的强度。这项研究的结果，特别是关于缺少与生物医学计划和联合预防相关的行为干预措施的系统审查，将使人口水平影响的增强数学建模成为可能。

 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.