同伴主导的干预措施对减少男男性行为者无保护肛交行为的效果：一项荟萃分析。
Efficacy of peer-led interventions to reduce unprotected anal intercourse among men who have sex with men: a meta-analysis.
作者信息
Ye Shaodong, Yin Lu, Amico Rivet, Simoni Jane, Vermund Sten, Ruan Yuhua, Shao Yiming, Qian Han-Zhu
机构信息
Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
出版信息
PLoS One. 2014 Mar 10;9(3):e90788. doi: 10.1371/journal.pone.0090788. eCollection 2014.
OBJECTIVE
To conduct a systematic review and meta-analysis to evaluate the efficacy of peer-led interventions in reducing unprotected anal intercourse (UAI) among men who have sex with men (MSM).
METHODS
Randomized clinical trials (RCTs), quasi-experimental studies, pre- and post-intervention studies without control groups, and serial cross-sectional assessments involving peers delivering interventions among MSM and published as of February 2012 were identified by systematically searching 13 electronic databases and cross-referencing. Effect sizes (ES) were calculated as the changes of standardized mean difference (SMD) in UAI between groups or pre-post intervention.
RESULTS
A total of 22 studies met the eligibility criteria, including five RCTs, six quasi-experimental studies, six pre-and-post intervention studies, and five serial cross-sectional intervention studies. We used 15 individual studies including 17 interventions for overall ES calculation; peer-led interventions reduced UAI with any sexual partners in meta-analysis (mean ES: -0.27; 95% confidence interval [CI]: -0.41, -0.13; P<0.01). Subgroup analyses demonstrated a statistically significant reduction on UAI in quasi-experimental studies (mean ES: -0.30; 95% CI: -0.50, -0.09; P = 0.01) and serial cross-sectional intervention studies (mean ES: -0.33; 95% CI: -0.57, -0.09; P = 0.01), but non-significant reduction in RCTs (mean ES: -0.15; 95% CI: -0.36, 0.07; P = 0.18) or pre- and post-intervention studies (mean ES: -0.29; 95% CI: -0.69, 0.11; P = 0.15). Heterogeneity was large across these 15 studies (I2 = 77.5%; P<0.01), largely due to pre-and-post intervention studies and serial cross-sectional intervention studies.
CONCLUSIONS
Peer-led HIV prevention interventions reduced the overall UAI among MSM, but the efficacy varied by study design. More RCTs are needed to evaluate the effect of peer-led interventions while minimizing potential bias.
目的
进行系统评价和荟萃分析，以评估同伴主导的干预措施在降低男男性行为者（MSM）无保护肛交（UAI）方面的效果。
方法
通过系统检索13个电子数据库并交叉引用，确定了截至2012年2月发表的随机临床试验（RCT）、准实验研究、无对照组的干预前后研究以及涉及同伴在男男性行为者中实施干预的系列横断面评估。效应量（ES）计算为组间或干预前后UAI标准化均数差（SMD）的变化。
结果
共有22项研究符合纳入标准，包括5项随机对照试验、6项准实验研究、6项干预前后研究和5项系列横断面干预研究。我们使用了15项个体研究（包括17项干预措施）进行总体效应量计算；在荟萃分析中，同伴主导的干预措施减少了与任何性伴侣的无保护肛交行为（平均效应量：-0.27；95%置信区间[CI]：-0.41，-0.13；P<0.01）。亚组分析表明，在准实验研究（平均效应量：-0.30；95%CI：-0.50，-0.09；P = 0.01）和系列横断面干预研究（平均效应量：-0.33；95%CI：-0.57，-0.09；P = 0.01）中，无保护肛交行为有统计学意义的减少，但在随机对照试验（平均效应量：-0.15；95%CI：-0.36，0.07；P = 0.18）或干预前后研究（平均效应量：-0.29；95%CI：-0.69，0.11；P = 0.15）中无显著减少。这15项研究的异质性很大（I2 = 77.5%；P<0.01），主要是由于干预前后研究和系列横断面干预研究。
结论
同伴主导的HIV预防干预措施降低了男男性行为者的总体无保护肛交行为，但效果因研究设计而异。需要更多的随机对照试验来评估同伴主导干预措施的效果，同时尽量减少潜在偏倚。
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