Department of HIV Interventions, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM), Uganda Research Unit, Entebbe, Uganda.
Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
PLoS One. 2021 Feb 4;16(2):e0246471. doi: 10.1371/journal.pone.0246471. eCollection 2021.
Expansion of Antiretroviral Therapy (ART) programs in sub-Saharan Africa (SSA) has increased the number of people accessing treatment. However, the number of males accessing and being retained along the human immunodeficiency virus (HIV) care cascade is significantly below the UNAIDS target. Male gender has been associated with poor retention in HIV care programs, and little is known about strategies that reduce attrition of men in ART programs. This review aimed to summarize any studies on strategies to improve retention of heterosexual males in HIV care in SSA. An electronic search was conducted through Ovid® for three databases (MEDLINE®, Embase and Global Health). Studies reporting interventions aimed at improving retention among heterosexual men along the HIV care cascade were reviewed. The inclusion criteria included randomized-controlled trials (RCTs), prospective or retrospective cohort studies that studied adult males (≥15years of age), conducted in SSA and published between January 2005 and April 2019 with an update from 2019 to 2020. The search returned 1958 articles, and 14 studies from eight countries met the inclusion criteria were presented using the PRISMA guidelines. A narrative synthesis was conducted. Six studies explored community-based adherence support groups while three compared use of facility versus community-based delivery models. Three studies measured the effect of national identity cards, disclosure of HIV status, six-monthly clinic visits and distance from the health center. Four studies measured risk of attrition from care using hazard ratios ranging from 1.2-1.8, four studies documented attrition proportions at an average of 40.0% and two studies an average rate of attrition of 43.4/1000PYs. Most (62%) included studies were retrospective cohorts, subject to risk of allocation and outcome assessment bias. A pooled analysis was not performed because of heterogeneity of studies and outcome definitions. No studies have explored heterosexual male- centered interventions in HIV care. However, in included studies that explored retention in both males and females, there were high rates of attrition in males. More male-centered interventions need to be studied preferably in RCTs. Registry number: PROSPERO2020 CRD42020142923 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923.
在撒哈拉以南非洲（SSA）扩大抗逆转录病毒疗法（ART）方案使更多人能够接受治疗。然而，获得治疗并沿着艾滋病毒（HIV）护理连续体保留下来的男性人数明显低于联合国艾滋病规划署（UNAIDS）的目标。男性性别与 HIV 护理方案中的保留率低有关，而对于减少 ART 方案中男性流失的策略知之甚少。本综述旨在总结任何关于改善 SSA 中 HIV 护理中异性恋男性保留率的策略研究。通过 Ovid®对三个数据库（MEDLINE®、Embase 和全球健康）进行了电子检索。对旨在提高 HIV 护理连续体中异性恋男性保留率的干预措施进行了研究。纳入标准包括随机对照试验（RCT）、前瞻性或回顾性队列研究，研究对象为成年男性（≥15 岁），在 SSA 进行，发表时间为 2005 年 1 月至 2019 年 4 月，2019 年至 2020 年更新。检索结果返回了 1958 篇文章，其中 8 个国家的 14 项研究符合纳入标准，按照 PRISMA 指南进行了呈现。采用叙述性综合法进行分析。6 项研究探索了基于社区的依从性支持小组，3 项研究比较了使用机构与社区提供模式。3 项研究测量了国民身份证、艾滋病毒状况披露、每六个月一次的诊所就诊和距离卫生中心的距离的影响。4 项研究使用风险比（1.2-1.8）衡量护理中断的风险，4 项研究记录了平均 40.0%的中断比例，2 项研究记录了平均 43.4/1000PYs 的中断率。大多数（62%）纳入研究为回顾性队列研究，存在分配和结局评估偏倚的风险。由于研究和结局定义的异质性，未进行汇总分析。没有研究探索过以异性恋男性为中心的 HIV 护理干预措施。然而，在纳入的研究中，同时探索了男性和女性的保留情况，男性的流失率很高。需要更多以男性为中心的干预措施进行研究，最好是在 RCT 中进行。注册号：PROSPERO2020 CRD42020142923 可从以下网址获得：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923。
