Kennedy Caitlin E, Fonner Virginia A, Armstrong Kevin A, O'Reilly Kevin R, Sweat Michael D
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland bDepartment of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, USA.
AIDS. 2015 Jun;29 Suppl 1(Suppl 1):S7-S23. doi: 10.1097/QAD.0000000000000671.
To review the effectiveness of interventions to increase HIV serostatus disclosure in low and middle-income countries.
Systematic review of peer-reviewed articles providing prepost or multiarm evaluations of disclosure interventions, defined broadly as any intervention with the goal of increasing rates of voluntary disclosure of HIV serostatus through self-disclosure or partner notification.
Articles were included if they reported postintervention evaluation results and were published between 1 January 1990 and 1 August 2014. Searching was conducted through five electronic databases, secondary searching of four journals, and hand searching reference lists of included articles. Systematic methods were used for screening and data abstraction, which was conducted in duplicate. Study quality (rigor) was assessed with eight items.
Fourteen articles evaluating 13 interventions met the inclusion criteria, all from sub-Saharan Africa. Most interventions focused on people living with HIV and used cognitive-behavioral group sessions or peer/community health worker support to encourage disclosure to sexual partners, family members, or friends. One focused on maternal disclosure to HIV-uninfected children, whereas two examined voluntary partner notification interventions. Several studies had limitations due to weak designs, small sample sizes, or high attrition. Findings on disclosure were mixed, with most effect sizes being relatively small, and some more rigorous studies showing no effect. Partner notification interventions had the strongest evidence of impact.
The existing evidence base for interventions to increase disclosure is limited and shows variable results. Further research is needed to determine whether current approaches to increasing disclosure are effective or whether new approaches should be considered.
回顾在低收入和中等收入国家提高艾滋病毒血清学状态披露率的干预措施的有效性。
对同行评审文章进行系统综述，这些文章提供了披露干预措施的前后测或多组评估，广义上定义为任何旨在通过自我披露或性伴通知提高艾滋病毒血清学状态自愿披露率的干预措施。
纳入报告干预后评估结果且发表于1990年1月1日至2014年8月1日之间的文章。通过五个电子数据库进行检索，对四种期刊进行二次检索，并手工检索纳入文章的参考文献列表。采用系统方法进行筛选和数据提取，由两人独立进行。用八项指标评估研究质量（严谨性）。
十四篇评估13项干预措施的文章符合纳入标准，均来自撒哈拉以南非洲。大多数干预措施针对艾滋病毒感染者，采用认知行为团体治疗或同伴/社区卫生工作者支持，以鼓励向性伴侣、家庭成员或朋友披露。一项措施侧重于母亲向未感染艾滋病毒的儿童披露，两项研究了自愿性伴通知干预措施。由于设计薄弱、样本量小或失访率高，几项研究存在局限性。关于披露的结果不一，大多数效应量相对较小，一些更严谨的研究显示无效果。性伴通知干预措施的影响证据最为充分。
关于提高披露率的干预措施的现有证据基础有限，结果不一。需要进一步研究以确定当前提高披露率的方法是否有效，或者是否应考虑新的方法。
