MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
AIDS. 2010 Oct;24 Suppl 4(Suppl 4):S81-92. doi: 10.1097/01.aids.0000390710.04255.2b.
Previous papers in this supplement have reviewed the evidence of the effectiveness of alternative HIV prevention methods from randomized controlled trials and other studies. This paper draws together the main conclusions from these reviews. A conceptual framework is presented that maps the proximal and distal determinants of sexual HIV transmission and helps to identify the stages in the causal pathway at which each intervention approach acts. The advances, gaps and challenges emerging from the reviews of individual intervention methods are summarized and cross-cutting themes identified. Approximately 90% of HIV prevention trials have found no effect on HIV incidence and we explore the alternative explanations for the large number of 'flat' trials. We conclude that there is no single explanation for these flat results, which may be due to interventions that are ineffective or inappropriately targeted or implemented, or to factors related to the design or conduct of trials. We examine the lessons from these flat results and provide recommendations on what should be done differently in future trials. HIV prevention remains of critical importance in an era of expanded delivery of antiretroviral therapy. In future HIV prevention research, it is important that resources are used as efficiently as possible to provide rigorous evidence of the effectiveness of a wider array of complementary prevention tools.
本增刊中的先前论文回顾了随机对照试验和其他研究中替代 HIV 预防方法的有效性证据。本文综合了这些综述的主要结论。提出了一个概念框架，该框架描绘了性传播 HIV 的近端和远端决定因素，并有助于确定每种干预方法作用的因果途径中的阶段。总结了对个别干预方法的审查中出现的进展、差距和挑战，并确定了跨领域的主题。大约 90%的 HIV 预防试验发现对 HIV 发病率没有影响，我们探讨了大量“平坦”试验的替代解释。我们得出的结论是，这些“平坦”结果没有单一的解释，这可能是由于干预措施无效或目标不明确或实施不当，或者与试验的设计或实施有关的因素。我们研究了这些平坦结果的经验教训，并就未来试验中应如何做出不同的改进提出了建议。在扩大提供抗逆转录病毒疗法的时代，HIV 预防仍然至关重要。在未来的 HIV 预防研究中，重要的是要尽可能有效地利用资源，提供更广泛的补充预防工具有效性的严格证据。
