Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
AIDS. 2020 Aug 1;34(10):1539-1548. doi: 10.1097/QAD.0000000000002582.
To determine the association between age-disparate relationships and risk of HIV infection among adolescent girls and young women (AGYW) aged 15-24 years.
Systematic review and meta-analysis of published studies until January 5, 2020 in sub Saharan Africa (SSA).
We searched several electronic databases, grey literature, and hand searched reference list of included studies to identify eligible studies for data abstraction. We assessed the quality of included studies using Newcastle-Ottawa Scale for nonrandomized studies. The DerSimonian-Laird random effects model was used to pool the overall results using risk ratios (RR), presented in a forest plot with 95% confidence interval (CI) and predictive interval. Heterogeneity was assessed with Cochrane's Q-test and quantified with I values. Publication bias was checked with funnel plots and Egger's test.
We included 24 studies with an overall sample size of 33 390. Data show that age-disparate relationships were significantly associated with unprotected sexual intercourse (pooled RR, 1.57; 95% CI, 1.34-1.83; 95% predictive interval, 1.22-2.02), and higher risk for HIV infection (pooled RR, 1.39; 95 CI, 1.21-1.60; 95% predictive interval, 0.80-2.42). Studies included in pooling risk of unprotected sexual intercourse were largely homogeneous (I-value= 0.0, P = 0.79) whereas those for HIV infection were heterogeneous (I- value = 89.0%, P < 0.01). We found no publication bias and no study influenced the meta-analytic results.
Age-disparate relationships among AGYW are associated with increased risk of unprotected sexual intercourse and HIV infection in SSA. HIV prevention interventions should target this sub-population.
确定年龄差异关系与 15-24 岁青少年女孩和年轻妇女（AGYW）感染艾滋病毒的风险之间的关联。
对撒哈拉以南非洲（SSA）截至 2020 年 1 月 5 日发表的研究进行系统评价和荟萃分析。
我们搜索了几个电子数据库、灰色文献，并对手头研究的参考文献进行了检索，以确定可用于数据提取的合格研究。我们使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评估纳入研究的质量。使用风险比（RR）汇总汇总结果，以森林图表示，置信区间（CI）和预测区间为 95%。使用 Cochrane 的 Q 检验评估异质性，并使用 I 值量化。使用漏斗图和 Egger 检验检查发表偏倚。
我们纳入了 24 项研究，总样本量为 33390 人。数据显示，年龄差异关系与无保护性行为显著相关（汇总 RR，1.57；95%CI，1.34-1.83；95%预测区间，1.22-2.02），并且感染艾滋病毒的风险更高（汇总 RR，1.39；95%CI，1.21-1.60；95%预测区间，0.80-2.42）。进行无保护性行为风险汇总的研究在很大程度上是同质的（I 值=0.0，P=0.79），而 HIV 感染的研究则存在异质性（I 值=89.0%，P<0.01）。我们没有发现发表偏倚，也没有研究影响荟萃分析结果。
SSA 中，AGYW 之间的年龄差异关系与无保护性行为和 HIV 感染风险增加有关。HIV 预防干预措施应针对这一亚人群。
