Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-1996, USA.
Bull World Health Organ. 2010 Aug 1;88(8):615-23. doi: 10.2471/BLT.09.068213. Epub 2010 May 28.
To assess the evidence for a differential effect of positive prevention interventions among individuals infected and not infected with human immunodeficiency virus (HIV) in developing countries, and to assess the effectiveness of interventions targeted specifically at people living with HIV.
We conducted a systematic review and meta-analysis of papers on positive prevention behavioural interventions in developing countries published between January 1990 and December 2006. Standardized methods of searching and data abstraction were used. Pooled effect sizes were calculated using random effects models.
Nineteen studies met the inclusion criteria. In meta-analysis, behavioural interventions had a stronger impact on condom use among HIV-positive (HIV+) individuals (odds ratio, OR: 3.61; 95% confidence interval, CI: 2.61-4.99) than among HIV-negative individuals (OR: 1.32; 95% CI: 0.77-2.26). Interventions specifically targeting HIV+ individuals also showed a positive effect on condom use (OR: 7.84; 95% CI: 2.82-21.79), which was particularly strong among HIV-serodiscordant couples (OR: 67.38; 95% CI: 36.17-125.52). Interventions included in this review were limited both in scope (most were HIV counselling and testing interventions) and in target populations (most were conducted among heterosexual adults or HIV-serodiscordant couples).
Current evidence suggests that interventions targeting people living with HIV in developing countries increase condom use, especially among HIV-serodiscordant couples. Comprehensive positive prevention interventions targeting diverse populations and covering a range of intervention modalities are needed to keep HIV+ individuals physically and mentally healthy, prevent transmission of HIV infection and increase the agency and involvement of people living with HIV.
评估在发展中国家，对感染和未感染人类免疫缺陷病毒（HIV）的个体实施正向预防干预的效果差异，并评估专门针对 HIV 感染者实施的干预措施的有效性。
我们对 1990 年 1 月至 2006 年 12 月期间发表的发展中国家正向预防行为干预的论文进行了系统评价和荟萃分析。采用标准的检索和数据提取方法。使用随机效应模型计算汇总的效应大小。
19 项研究符合纳入标准。荟萃分析显示，行为干预对 HIV 阳性（HIV+）个体的避孕套使用（优势比，OR：3.61；95%置信区间，CI：2.61-4.99）比 HIV 阴性个体（OR：1.32；95%CI：0.77-2.26）更有影响。专门针对 HIV+个体的干预措施也对避孕套使用产生了积极影响（OR：7.84；95%CI：2.82-21.79），在 HIV 血清不一致的夫妇中尤其明显（OR：67.38；95%CI：36.17-125.52）。本研究纳入的干预措施在范围（大多数是 HIV 咨询和检测干预）和目标人群（大多数是异性恋成年人或 HIV 血清不一致的夫妇）上都受到限制。
现有证据表明，在发展中国家针对 HIV 感染者的干预措施可以增加避孕套的使用，尤其是在 HIV 血清不一致的夫妇中。需要针对不同人群实施全面的正向预防干预措施，涵盖多种干预模式，以保持 HIV 感染者的身心健康，预防 HIV 感染的传播，并增强 HIV 感染者的能动性和参与度。
