Underwood Carol, Hendrickson Zoé, Van Lith Lynn M, Lengwe Kunda John Eudes, Mallalieu Elizabeth C
*Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; †Center for Communication Programs, Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; and ‡Department of Public Health & Policy, London School of Hygiene and Tropical Medicine, Lusaka, Zambia.
J Acquir Immune Defic Syndr. 2014 Aug 15;66 Suppl 3:S311-8. doi: 10.1097/QAI.0000000000000234.
Addressing community-level factors (CLFs) is integral to the ongoing effort to design multilevel, effective, and sustainable interventions to address each element of the HIV/AIDS treatment cascade. This review, the first critical review of this topic, identified 100 articles that (1) assessed CLFs in relation to the HIV/AIDS treatment cascade, (2) had been peer-reviewed, and (3) were based on studies conducted in low- or middle-income countries. Social support and social networks, cultural norms, gender norms, and stigma were the key CLFs associated with treatment and care. This extensive review found only 5 evaluations of interventions designed to affect CLFs, reflecting a major gap in the literature. All were communication interventions designed to create a more positive environment for HIV testing and access to treatment and care, thus pointing to some of the potential extraindividual effects of communication interventions. The qualitative data are rich and vital for understanding the context; yet, more quantitative analysis to provide evidence regarding the distribution of these factors is essential, as only 19 of the studies were quantitative. There is a pressing need to (1) collect community-level data, (2) validate social and gender norm scales, and (3) better use available data regarding social norms, gender norms, and other CLFs. These data could be aggregated at the cluster, neighborhood, or community levels and incorporated into multilevel analysis to help clarify the pathways to enhanced outcomes across the treatment cascade and thereby mitigate HIV sequelae.
解决社区层面因素（CLFs）是当前设计多层次、有效且可持续干预措施以应对艾滋病毒/艾滋病治疗级联各个环节的努力的组成部分。本综述是对该主题的首次批判性综述，共识别出100篇文章，这些文章（1）评估了与艾滋病毒/艾滋病治疗级联相关的社区层面因素，（2）经过同行评审，且（3）基于在低收入或中等收入国家开展的研究。社会支持与社会网络、文化规范、性别规范以及耻辱感是与治疗和护理相关的关键社区层面因素。这一广泛综述仅发现5项针对旨在影响社区层面因素的干预措施的评估，这反映出文献中的一个重大空白。所有这些评估均为沟通干预措施，旨在为艾滋病毒检测以及获得治疗和护理创造更积极的环境，从而指出了沟通干预措施的一些潜在个体外效应。定性数据对于理解背景情况丰富且至关重要；然而，由于仅有19项研究为定量研究，因此进行更多定量分析以提供有关这些因素分布的证据至关重要。迫切需要（1）收集社区层面的数据，（2）验证社会和性别规范量表，以及（3）更好地利用关于社会规范、性别规范和其他社区层面因素的现有数据。这些数据可在群组、邻里或社区层面进行汇总，并纳入多层次分析，以帮助厘清整个治疗级联中改善结果的途径，从而减轻艾滋病毒后遗症。
