University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
Infectious Disease Institute, Makerere University, P.O. Box 22418, Kampala, Uganda.
Int J Infect Dis. 2020 Dec;101:326-333. doi: 10.1016/j.ijid.2020.09.1476. Epub 2020 Oct 2.
This systematic review aims to qualitatively synthesize existing evidence on the efficacy of HIV interventions in African fishing communities.
Five databases (NCBI PubMed, EMBASE, Web of Science Core Collection, The Cochrane Library, and CABI Global Health Database) were searched in March 2019 for eligible studies. All peer-reviewed papers with a defined HIV intervention explicitly mentioning African fishing communities were included. Outcomes included any measure of the efficacy of HIV interventions.
Of 22,289 search results, data was extracted from 25 eligible studies that passed critical appraisal; seven involved HIV prevention, six HIV testing and counseling, three treatment, and nine combinations of more than one intervention. Findings include a high coverage of safe male circumcision (SMC) but low condom use among fisher folk, and a preference for PrEP over other HIV prevention services. Uptake of HIV testing and ART coverage are below levels required to reach UNAIDS 90-90-90 targets, and there is a high demand for ART and HIV self-testing kits.
Greater provision of services to combat HIV, specifically amongst fishing communities, is required; there is limited information on retaining fisher folk in care and achieving an undetectable viral load. Interventions tailored to individual fishing populations, offered in parallel to education or counseling services are likely to be most effective. Use of innovations, including mobile health and medical drones, could assist these hard-to-reach populations. Our findings will inform future HIV service provision in fishing communities.
本系统评价旨在定性综合现有关于非洲渔业社区艾滋病毒干预措施效果的证据。
2019 年 3 月，我们在 5 个数据库（美国国立卫生研究院生物医学文献数据库（NCBI PubMed）、Embase、Web of Science 核心合集、考科兰图书馆和 CABI 全球健康数据库）中搜索了符合条件的研究。纳入了所有明确提及非洲渔业社区的艾滋病毒干预措施的同行评审论文。结局指标包括艾滋病毒干预措施效果的任何衡量指标。
在 22289 项检索结果中，有 25 项符合条件的研究通过了严格评价，数据从中提取；其中 7 项涉及艾滋病毒预防，6 项涉及艾滋病毒检测和咨询，3 项涉及治疗，9 项涉及不止一种干预措施的组合。研究结果包括男性普遍接受了安全性行为，但渔民的避孕套使用率仍然较低，以及人们更倾向于使用暴露前预防（PrEP）而不是其他艾滋病毒预防服务。艾滋病毒检测和抗逆转录病毒治疗（ART）的覆盖率均低于实现联合国艾滋病规划署 90-90-90 目标所需的水平，对 ART 和艾滋病毒自检试剂盒的需求很高。
需要更多地提供服务来防治艾滋病毒，特别是在渔业社区；关于如何让渔民继续接受治疗并实现病毒载量无法检测到的信息有限。针对特定渔业人群量身定制的干预措施，与教育或咨询服务并行提供，可能最有效。使用创新手段，包括移动医疗和医疗无人机，可能有助于覆盖这些难以接触的人群。我们的研究结果将为未来在渔业社区提供艾滋病毒服务提供信息。
