Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, , Storrs, Connecticut, USA.
Sex Transm Infect. 2013 Dec;89(8):620-7. doi: 10.1136/sextrans-2013-051135. Epub 2013 Aug 5.
The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy.
A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression.
Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use.
Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.
本研究旨在综合评估基于伴侣的 HIV 预防干预措施，评估这些干预措施在降低性风险方面的效果，并确定干预效果的调节因素。
全面的文献检索确定了 29 项符合纳入标准的干预措施（22 份报告；N=5168 对夫妇），包括招募异性恋夫妇的双方成员、在基线和随访时测量避孕套使用情况以及有足够的统计信息来计算效应大小。使用固定效应和随机效应假设分析效应大小；使用荟萃回归确定与干预效果相关的因素。
总体而言，从基线到随访，避孕套使用显著增加（d+=0.78，95%CI 0.48 至 1.09），伴侣同时性显著减少（d+=0.37，95%CI 0.13 至 0.60）。当研究在疫情早期进行、在人类发展指数得分较低的国家进行、招募血清不一致的夫妇以及在多种情况下提供干预内容时，避孕套使用增加的幅度更大。在一起时间较长、报告性传播感染发生率较高、提供自愿咨询和检测以及在面对面访谈中提供结果测量的夫妇，报告的避孕套使用增加幅度也更大。
基于伴侣的干预措施在浪漫关系背景下减少无保护性行为是有效的。未来的研究应继续提高对伴侣的风险降低效果。
