Ojo Olumuyiwa, Verbeek Jos H, Rasanen Kimmo, Heikkinen Jarmo, Isotalo Leena K, Mngoma Nomusa, Ruotsalainen Eija
Institute of Public Health and Clinical Nutrition, Occupational Health Unit, University of Eastern Finland, Yliopistonranta 1 C, B/3. Krs, Kuopio, Finland, FI-70211.
Cochrane Database Syst Rev. 2011 Dec 7(12):CD005274. doi: 10.1002/14651858.CD005274.pub3.
The workplace provides an important avenue to prevent HIV.
To evaluate the effect of behavioral interventions for reducing HIV on high risk sexual behavior when delivered in an occupational setting.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO up until March 2011 and CINAHL, LILACS, DARE, OSH Update, and EPPI database up until October 2010.
Randomised control trials (RCTs) in occupational settings or among workers at high risk for HIV that measured HIV, sexual transmitted diseases (STD), Voluntary Counseling and Testing (VCT), or risky sexual behaviour.
Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias. We pooled studies that were similar.
We found 8 RCTs with 11,164 participants but one study did not provide enough data. Studies compared VCT to no VCT and education to no intervention and to alternative education.VCT uptake increased to 51% when provided at the workplace compared to a voucher for VCT (RR=14.0 (95% CI 11.8 to16.7)). After VCT, self-reported STD decreased (RR = 0.10 (95% CI 0.01 to 0.73)) but HIV incidence (RR=1.4 (95% CI 0.7 to 2.7)) and unprotected sex (RR=0.71 (0.48 to 1.06)) did not decrease significantly. .Education reduced STDs (RR = 0.68 (95%CI 0.48 to 0.96)), unprotected sex (Standardised Mean Difference (SMD)= -0.17 (95% CI -0.29 to -0.05), sex with a commercial sex worker (RR = 0.88 (95% CI 0.81 to 0.96) but not multiple sexual partners (Mean Difference (MD) = -0.22 (95% CI -0.52 to 0.08) nor use of alcohol before sex (MD = -0.01 (95% CI of -0.11 to 0.08).
AUTHORS' CONCLUSIONS: Workplace interventions to prevent HIV are feasible. There is moderate quality evidence that VCT offered at the work site increases the uptake of testing. Even though this did no lower HIV-incidence, there was a decrease in self-reported sexual transmitted diseases and a decrease in risky sexual behaviour. There is low quality evidence that educational interventions decrease sexually transmitted diseases, unprotected sex and sex with commercial sex workers but not sex with multiple partners and the use of alcohol before sex.More and better randomised trials are needed directed at high risk groups such as truck drivers or workers in areas with a very high HIV prevalence such as Southern Africa. Risky sexual behaviour should be measured in a standardised way.
工作场所是预防艾滋病病毒的重要途径。
评估在职业环境中实施行为干预措施对减少高危性行为及预防艾滋病病毒的效果。
截至2011年3月，我们检索了考克兰对照试验中央注册库、医学索引在线、荷兰医学文摘数据库和心理学文摘数据库；截至2010年10月，检索了护理学与健康领域数据库、拉丁美洲和加勒比卫生科学数据库、循证医学图书馆、职业安全与健康更新数据库及教育优先项目信息与协调中心数据库。
在职业环境中或针对艾滋病病毒高危人群开展的随机对照试验，这些试验需测量艾滋病病毒、性传播疾病、自愿咨询检测或危险性行为。
两名评审员独立筛选纳入研究、提取数据并评估偏倚风险。我们将相似的研究进行了合并。
我们找到8项随机对照试验，涉及11164名参与者，但有一项研究未提供足够数据。这些研究比较了自愿咨询检测与无自愿咨询检测的情况，以及教育干预与无干预及替代教育的情况。与提供自愿咨询检测代金券相比，在工作场所提供自愿咨询检测时，其接受率增至51%（相对危险度=14.0（95%可信区间11.8至16.7））。接受自愿咨询检测后，自我报告的性传播疾病有所减少（相对危险度=0.10（95%可信区间0.01至0.73）），但艾滋病病毒感染率（相对危险度=1.4（95%可信区间0.7至2.7））和无保护性行为（相对危险度=0.71（0.48至1.06））并未显著下降。教育干预减少了性传播疾病（相对危险度=0.68（95%可信区间0.48至0.96））、无保护性行为（标准化均数差=-0.17（95%可信区间-0.29至-0.05））以及与商业性工作者发生性行为的情况（相对危险度=0.88（95%可信区间0.81至0.96）），但未减少性伴侣数量（均数差=-0.22（95%可信区间-0.52至0.08）），也未减少性行为前饮酒的情况（均数差=-0.01（95%可信区间-0.11至0.08））。
工作场所预防艾滋病病毒的干预措施是可行的。有中等质量证据表明，在工作场所提供自愿咨询检测可提高检测接受率。尽管这并未降低艾滋病病毒感染率，但自我报告的性传播疾病有所减少，危险性行为也有所减少。有低质量证据表明，教育干预可减少性传播疾病、无保护性行为以及与商业性工作者发生性行为的情况，但不能减少性伴侣数量和性行为前饮酒的情况。需要针对高危人群，如卡车司机或艾滋病病毒感染率极高地区（如南部非洲）的工人，开展更多更好的随机试验。危险性行为应以标准化方式进行测量。
