*Women's Global Health Imperative, RTI International, San Francisco, CA; and †Department of Infectious Disease Epidemiology, MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Acquir Immune Defic Syndr. 2014 Jul 1;66 Suppl 2:S154-69. doi: 10.1097/QAI.0000000000000178.
BACKGROUND: In 2012, an estimated 2.1 million adolescents were living with HIV. Though there are effective interventions to prevent and treat HIV infection, adolescents face specific barriers in accessing them. As a result, new infections and poor outcomes among HIV-infected adolescents are common. HIV programming for adolescents should focus on interventions of proven effectiveness and address underlying factors driving incidence and lack of effective treatment and care in this age group. METHODS: We conducted a systematic review of systematic reviews to summarize the global data on effectiveness of 20 intervention types, to identify characteristics of effective interventions, and to explore evidence of how adolescents can access interventions with proven effectiveness. Interventions were in 2 broad categories: those designed primarily for adults and those designed specifically for adolescents. Where available, we evaluated the evidence of impact on the key outcomes: HIV risk, HIV transmission, and HIV morbidity and mortality. RESULTS: Among the interventions designed for adolescents, there was high-quality evidence that in-school interventions and some interventions in geographically defined communities can positively impact important HIV-related outcomes, such as self-reported sexual risk behaviors. Interventions designed primarily for adults that had high-quality, consistent biological evidence of efficacy included voluntary medical male circumcision (VMMC), antiretrovirals for the prevention of mother-to-child transmission, HIV testing and counseling, HIV treatment, condom use, and provision of sterile injecting equipment to people who inject drugs. There was also an evidence of potential efficacy for oral preexposure prophylaxis and behavior change interventions among certain populations. There was a dearth of systematic review data on how best to enable adolescents to access the intervention types identified as having proven effectiveness among adults. CONCLUSIONS: This series of reviews allowed us to rigorously and systematically review a large number of intervention types at once using a standard, transparent methodology. Eight key interventions showed clear evidence of effectiveness, with evidence of potential efficacy for some additional interventions among certain populations. DISCUSSION: These priority interventions with proven effectiveness should be included in all HIV prevention programming for adolescents. There is a pressing need for more rigorous research on how best to enable adolescents to access these effective interventions.
背景:2012 年,约有 210 万青少年感染了 HIV。尽管有预防和治疗 HIV 感染的有效干预措施,但青少年在获得这些措施时面临着特定的障碍。因此,新的感染和 HIV 感染青少年的不良结局很常见。针对青少年的 HIV 规划应侧重于具有明确效果的干预措施,并解决导致该年龄段发病率和缺乏有效治疗和护理的根本因素。
方法:我们对系统评价进行了系统评价,以总结全球 20 种干预类型有效性的数据,确定有效干预措施的特征,并探讨如何让青少年获得具有明确效果的干预措施的证据。干预措施分为两大类:主要为成年人设计的干预措施和专门为青少年设计的干预措施。在有可用数据的情况下,我们评估了对关键结果(HIV 风险、HIV 传播以及 HIV 发病率和死亡率)产生影响的证据。
结果:在为青少年设计的干预措施中,有高质量的证据表明,在学校内进行的干预措施和在地理上确定的社区内进行的一些干预措施可以对重要的 HIV 相关结果产生积极影响,例如自我报告的性行为风险。主要为成年人设计的干预措施,如果具有高质量、一致的生物学疗效证据,则包括自愿男性包皮环切术(VMMC)、抗逆转录病毒药物预防母婴传播、HIV 检测和咨询、HIV 治疗、安全套使用以及为注射毒品者提供无菌注射设备。在某些人群中,口服暴露前预防和行为改变干预措施也具有潜在疗效的证据。对于如何最好地使青少年获得已确定对成年人有效的干预措施类型,系统评价数据非常匮乏。
结论:这一系列的评价使我们能够使用标准化、透明的方法同时严格而系统地评价大量的干预措施类型。八项关键干预措施具有明确的效果证据,在某些人群中,某些额外的干预措施具有潜在的效果。
讨论:具有明确效果的这些重点干预措施应纳入所有针对青少年的 HIV 预防规划中。迫切需要对如何使青少年最好地获得这些有效干预措施进行更严格的研究。
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