aFaculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK bMassachusetts Department of Environmental Protection, Boston, Massachusetts cUNC Water Institute, University of North Carolina dInstitute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.
AIDS. 2013 Oct 23;27(16):2593-601. doi: 10.1097/QAD.0b013e3283633a5f.
People living with HIV/AIDS (PLHIV) are at increased risk of diarrhoeal disease and enteric infection. This review assesses the effectiveness of water, sanitation, and hygiene (WASH) interventions to prevent disease among PLHIV.
We searched MEDLINE, EMBASE, Global Health, The Cochrane Library, Web of Science, LILACS, Africa-wide, IMEMR, IMSEAR, WPRIM, CNKI, and WanFang. We also hand searched conference proceedings, contacted researchers and organizations, and checked references from identified studies. Eligible studies were those involving WASH interventions among PLHIV that reported on health outcomes and employed a controlled study design. We extracted data, explored heterogeneity, sub-grouped based on outcomes, calculated pooled effects on diarrhoeal disease using meta-analysis, and assessed studies for methodological quality.
Ten studies met the eligibility criteria and are included in the review, of which nine involved water quality interventions and one involved promotion of handwashing. Among eight studies that reported on diarrhoea, water quality interventions (seven studies, pooled RR = 0.57, 95% CI: 0.38-0.86) and the handwashing intervention (one study, RR = 0.42, 95% CI: 0.33-0.54) were protective against diarrhoea. One study reported that household water treatment combined with insecticide treated bednets slowed the progression of HIV/AIDS. The validity of most studies is potentially compromised by methodological shortcomings.
No studies assessed the impact of improved water supply or sanitation, the most fundamental of WASH interventions. Despite some evidence that water quality interventions and handwashing are protective against diarrhoea, substantial heterogeneity and the potential for bias raise questions about the actual level of protection.
艾滋病毒/艾滋病感染者（PLHIV）患腹泻病和肠道感染的风险增加。本综述评估了水、环境卫生和个人卫生（WASH）干预措施预防 PLHIV 疾病的有效性。
我们检索了 MEDLINE、EMBASE、全球卫生、考科蓝图书馆、Web of Science、LILACS、非洲范围、IMEMR、IMSEAR、WPRIM、CNKI 和万方。我们还手动搜索了会议记录，联系了研究人员和组织，并检查了已确定研究的参考文献。符合条件的研究是指在 PLHIV 中进行 WASH 干预，报告健康结果并采用对照研究设计的研究。我们提取数据，探索异质性，根据结果进行分组，使用荟萃分析计算腹泻病的汇总效应，并评估研究的方法学质量。
有 10 项研究符合纳入标准，并包含在综述中，其中 9 项涉及水质干预，1 项涉及促进洗手。在报告腹泻的 8 项研究中，水质干预（7 项研究，汇总 RR=0.57，95%CI：0.38-0.86）和洗手干预（1 项研究，RR=0.42，95%CI：0.33-0.54）均能预防腹泻。一项研究报告称，家庭水处理与驱虫蚊帐相结合可减缓艾滋病病毒/艾滋病的进展。大多数研究的有效性可能因方法学缺陷而受到影响。
没有研究评估改善供水或卫生设施的影响，这是 WASH 干预的最基本措施。尽管有一些证据表明水质干预和洗手可以预防腹泻，但存在很大的异质性和潜在的偏倚，这使得实际的保护水平存在疑问。
