van-Velthoven Michelle H M M T, Tudor Car Lorainne, Gentry Sarah, Car Josip
Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London,UK.
Cochrane Database Syst Rev. 2013 May 31(5):CD009190. doi: 10.1002/14651858.CD009190.pub2.
This is one of the three Cochrane reviews that examine the role of the telephone in HIV/AIDS services. Although HIV infection can be prevented, still a large number of new infections occur. More effective HIV prevention interventions are needed to reduce the number of people newly infected with HIV. Phone calls can be used to potentially more effectively deliver HIV prevention interventions. They have the potential to save time, reduce costs and facilitate easier access.
To assess the effectiveness of voice landline and mobile telephone delivered HIV prevention interventions in HIV-negative persons.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, Web of Science, Cumulative Index to Nursing & Allied Health, the World Health Organization's Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International and the Centre for Agricultural Bioscience International Direct Global Health database, the System for Information on Grey Literature Europe, The Healthcare Management Information Consortium, Google Scholar, Conference on Retroviruses and Opportunistic Infections database, International AIDS Society conference database, AIDS Education Global Information System and reference lists of articles.
Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of delivering HIV prevention by phone calls to usual care in HIV-negative people regardless of their demographic characteristics and in all settings.
Two reviewers independently searched databases, screened citations, assessed study quality and extracted data. A third reviewer resolved any disagreement. Primary outcomes were knowledge about the causes and consequences of HIV/AIDS, change in behaviour, healthcare uptake and clinical outcomes. Secondary outcomes were users' and providers' views on the intervention, economic outcomes and adverse outcomes.
Out of 14,717 citations, only one study met the inclusion criteria. The included RCT recruited women and girl children who received post-exposure prophylaxis (PEP) after rape from sexual assault services in South Africa between August 2007 and May 2008.Participants (n (number) =274) were randomised into a telephone support (n=136) and control (n=138) group. Control group participants received usual care (an interactive information session) from the sexual assault service during the 28 days in which they had to take PEP, with no further contact from the study staff. Telephone support group participants received standard care and phone calls from a counsellor throughout the 28 days when they had to take PEP.Overall, adherence to PEP was not significantly (P=0.13) different between the intervention (38.2%) and control (31.9 %) groups. Also, the proportion of participants who read a pamphlet, did not return to collect medication or with a depression were not significantly different between the intervention and control groups (P=0.006, P=0.42, P=0.72 respectively). The proportion of participants who used a diary was significantly (P=0.001) higher in the intervention group (78.8%) versus the control group (69.9%). The study authors reported that there were no recorded adverse events. The RCT did not provide information about participants' and providers' evaluation outcomes, or economic outcomes. The study had a moderate risk of bias.
AUTHORS' CONCLUSIONS: We found only one RCT, with a moderate risk of bias, which showed that providing PEP support by phone calls did not result in higher adherence to PEP. However, the RCT was conducted in an upper-middle-income country with high HIV prevalence, on a high-risk population and the applicability of its results on other settings and contexts is unclear. There is a need for robust evidence from various settings on the effectiveness of using phone calls for providing PEP support and for other HIV prevention interventions.
这是三项考克兰系统评价之一，旨在探讨电话在艾滋病毒/艾滋病服务中的作用。尽管艾滋病毒感染可被预防，但仍有大量新感染病例出现。需要更有效的艾滋病毒预防干预措施来减少新感染艾滋病毒的人数。电话可用于更有效地提供艾滋病毒预防干预措施。它们有可能节省时间、降低成本并便于更易获得服务。
评估通过固定电话和移动电话提供的艾滋病毒预防干预措施对艾滋病毒阴性者的有效性。
我们检索了考克兰对照试验中央登记库、医学索引数据库、美国国立医学图书馆数据库、荷兰医学文摘数据库、心理学文摘数据库、科学引文索引数据库、护理学与健康相关学科累积索引、世界卫生组织全球健康图书馆以及1980年至2011年6月的当前对照试验。我们检索了以下灰色文献来源：国际学位论文摘要数据库、国际农业生物科学中心全球健康直接数据库、欧洲灰色文献信息系统、医疗管理信息联盟、谷歌学术、逆转录病毒与机会性感染会议数据库、国际艾滋病学会会议数据库、艾滋病教育全球信息系统以及文章的参考文献列表。
随机对照试验、半随机对照试验、前后对照研究以及中断时间序列研究，比较通过电话提供艾滋病毒预防措施与常规护理对艾滋病毒阴性者（无论其人口统计学特征如何）在所有环境中的有效性。
两名综述作者独立检索数据库、筛选文献、评估研究质量并提取数据。第三名综述作者解决任何分歧。主要结局包括对艾滋病毒/艾滋病病因和后果的知识、行为改变、医疗服务利用情况和临床结局。次要结局包括使用者和提供者对干预措施的看法、经济结局和不良结局。
在14717篇文献中，只有一项研究符合纳入标准。纳入的随机对照试验招募了2007年8月至2008年5月期间在南非性侵犯服务机构遭受强奸后接受暴露后预防（PEP）的妇女和女童。参与者（n = 274）被随机分为电话支持组（n = 136）和对照组（n = 138）。对照组参与者在必须服用PEP的28天内接受性侵犯服务机构提供的常规护理（一次互动信息会），研究人员不再进一步联系。电话支持组参与者在必须服用PEP的28天内接受标准护理并收到咨询师的电话。总体而言，干预组（38.2%）和对照组（31.9%）的PEP依从性无显著差异（P = 0.13）。此外，阅读宣传册、未返回取药或患有抑郁症的参与者比例在干预组和对照组之间也无显著差异（分别为P = 0.006、P = 0.42、P = 0.72）。干预组使用日记的参与者比例（78.8%）显著高于对照组（69.9%）（P = 0.001）。研究作者报告未记录到不良事件。该随机对照试验未提供关于参与者和提供者评估结局或经济结局的信息。该研究存在中度偏倚风险。
我们仅发现一项存在中度偏倚风险的随机对照试验，该试验表明通过电话提供PEP支持并未导致更高的PEP依从性。然而，该随机对照试验是在艾滋病毒高流行的中高收入国家针对高风险人群进行的，其结果在其他环境和背景下的适用性尚不清楚。需要来自各种环境的有力证据来证明使用电话提供PEP支持及其他艾滋病毒预防干预措施的有效性。
