美国基于社区的避孕套分发干预措施预防艾滋病病毒的有效性：一项系统评价与荟萃分析。
Effectiveness of community-based condom distribution interventions to prevent HIV in the United States: A systematic review and meta-analysis.
作者信息
Malekinejad Mohsen, Parriott Andrea, Blodgett Janet C, Horvath Hacsi, Shrestha Ram K, Hutchinson Angela B, Volberding Paul, Kahn James G
机构信息
Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America.
Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America.
出版信息
PLoS One. 2017 Aug 3;12(8):e0180718. doi: 10.1371/journal.pone.0180718. eCollection 2017.
BACKGROUND
Despite significant public health implications, the extent to which community-based condom distribution interventions (CDI) prevent HIV infection in the United States is not well understood.
METHODS
We systematically reviewed research evidence applying Cochrane Collaboration methods. We used a comprehensive search strategy to search multiple bibliographic databases for relevant randomized controlled trials (RCTs) and non-RCTs published from 1986-2017. We focused on CDI that made condoms widely available or accessible in community settings. Eligible outcomes were HIV infection (primary), sexually transmitted infections, condom use, and multiple sexual partnership. Two reviewers independently screened citations to assess their eligibility, extracted study data, and assessed risk of bias. We calculated risk ratios (RR) with 95% confidence intervals (CI) and pooled them using random-effects models. We assessed evidence quality using GRADE.
RESULTS
We reviewed 5,110 unique records. Nine studies (including one RCT) met eligibility criteria. Studies were conducted in 10 US states between 1989 and 2011. All studies were at high risk of bias. Interventions were categorized into three groups: "Ongoing" (unlimited access to condoms), "Ongoing-plus" (unlimited access to condoms, with co-interventions), and "Coupon-based" (coupons redeemed for condoms). No studies reported incident HIV. Ongoing CDI (four non-RCTs) modestly reduced condomless sex (RR 0.88, 95% CI 0.78 to 0.99). Ongoing-plus CDI (two non-RCTs) significantly reduced multiple sexual partnership (RR 0.37, 95% CI 0.16 to 0.87). Of two coupon-based studies, one (non-RCT) showed reduction in condomless sex in female participants (Odds Ratio 0.67, 95% CI 0.47 to 0.96), while the other one (RCT) showed no effect on STI incidence (RR 0.91, 95% CI 0.63 to 1.31). Evidence quality was "very low" for all outcomes.
CONCLUSIONS
CDI may reduce some risky sexual behaviors, but the evidence for any reduction is limited and of low-quality. Lack of biological outcomes precludes assessing the link between CDI and HIV incidence.
背景
尽管具有重大的公共卫生意义，但基于社区的避孕套分发干预措施（CDI）在美国预防艾滋病毒感染的程度尚未得到充分了解。
方法
我们采用Cochrane协作方法系统地回顾了研究证据。我们使用全面的检索策略在多个文献数据库中检索1986年至2017年发表的相关随机对照试验（RCT）和非随机对照试验。我们关注的是在社区环境中使避孕套广泛可得或可获取的CDI。符合条件的结果包括艾滋病毒感染（主要结果）、性传播感染、避孕套使用和多个性伴侣。两名评审员独立筛选文献以评估其是否符合条件，提取研究数据，并评估偏倚风险。我们计算了风险比（RR）及其95%置信区间（CI），并使用随机效应模型进行汇总。我们使用GRADE评估证据质量。
结果
我们回顾了5110条独特记录。九项研究（包括一项RCT）符合纳入标准。这些研究于1989年至2011年在美国的10个州进行。所有研究都存在较高的偏倚风险。干预措施分为三组：“持续提供”（无限制获取避孕套）、“持续提供加”（无限制获取避孕套，并伴有联合干预措施）和“基于优惠券”（用优惠券兑换避孕套）。没有研究报告新发艾滋病毒感染情况。“持续提供”的CDI（四项非RCT）适度减少了无保护性行为（RR 0.88，95%CI 0.78至0.99）。“持续提供加”的CDI（两项非RCT）显著减少了多个性伴侣的情况（RR 0.37，95%CI 0.16至0.87）。在两项基于优惠券的研究中，一项（非RCT）显示女性参与者的无保护性行为有所减少（优势比0.67，95%CI 0.47至0.96），而另一项（RCT）显示对性传播感染发病率没有影响（RR 0.91，95%CI 0.63至1.31）。所有结果的证据质量均为“非常低”。
结论
CDI可能会减少一些危险的性行为，但关于任何减少效果的证据有限且质量较低。缺乏生物学结果妨碍了评估CDI与艾滋病毒发病率之间的联系。
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