同伴支持对 HIV 感染者有效性的系统评价和荟萃分析。

The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis.

机构信息

Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.

Institute of Community Medicine, University of Tromsø, Tromsø, Norway.

出版信息

PLoS One. 2021 Jun 17;16(6):e0252623. doi: 10.1371/journal.pone.0252623. eCollection 2021.

DOI:10.1371/journal.pone.0252623

PMID:34138897

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8211296/

Abstract

BACKGROUND

The practice of involving people living with HIV in the development and provision of healthcare has gained increasing traction. Peer-support for people living with HIV is assistance and encouragement by an individual considered equal, in taking an active role in self-management of their chronic health condition. The objective of this systematic review was to assess the effects of peer-support for people living with HIV.

METHODS

We conducted a systematic review in accordance with international guidelines. Following systematic searches of eight databases until May 2020, two reviewers performed independent screening of studies according to preset inclusion criteria. We conducted risk of bias assessments and meta-analyses of the available evidence in randomised controlled trials (RCTs). The certainty of the evidence for each primary outcome was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation system.

RESULTS

After screening 219 full texts we included 20 RCTs comprising 7605 participants at baseline from nine different countries. The studies generally had low risk of bias. Main outcomes with high certainty of evidence showed modest, but superior retention in care (Risk Ratio [RR] 1.07; Confidence Interval [CI] 95% 1.02-1.12 at 12 months follow-up), antiretroviral therapy (ART) adherence (RR 1.06; CI 95% 1.01-1.10 at 3 months follow-up), and viral suppression (Odds Ratio up to 6.24; CI 95% 1.28-30.5 at 6 months follow-up) for peer-support participants. The results showed that the current state of evidence for most other main outcomes (ART initiation, CD4 cell count, quality of life, mental health) was promising, but too uncertain for firm conclusions.

CONCLUSIONS

Overall, peer-support with routine medical care is superior to routine clinic follow-up in improving outcomes for people living with HIV. It is a feasible and effective approach for linking and retaining people living with HIV to HIV care, which can help shoulder existing services.

TRIAL REGISTRATION

CRD42020173433.

摘要

背景

让艾滋病病毒感染者参与医疗保健的开发和提供已成为一种趋势。艾滋病病毒感染者的同伴支持是指由被认为平等的个体提供援助和鼓励，以积极参与自身慢性健康状况的自我管理。本系统评价的目的是评估同伴支持对艾滋病病毒感染者的影响。

方法

我们按照国际指南进行了系统评价。通过对截至 2020 年 5 月的 8 个数据库进行系统检索，两名审查员根据预设的纳入标准独立筛选研究。我们对随机对照试验（RCT）中的可用证据进行了风险偏倚评估和荟萃分析。使用推荐评估、制定与评价系统对每个主要结局的证据确定性进行评估。

结果

在筛选了 219 篇全文后，我们纳入了 20 项 RCT，这些研究共纳入了来自 9 个不同国家的 7605 名基线参与者。这些研究的偏倚风险通常较低。具有高确定性证据的主要结局显示，同伴支持组在治疗保留率（12 个月随访时，风险比 [RR] 1.07；95%置信区间 [CI] 1.02-1.12）、抗逆转录病毒治疗（ART）依从性（3 个月随访时，RR 1.06；95%CI 1.01-1.10）和病毒抑制率（6 个月随访时，比值比高达 6.24；95%CI 1.28-30.5）方面有适度但更好的效果。结果表明，目前大多数其他主要结局（ART 起始、CD4 细胞计数、生活质量、心理健康）的证据状态很有前景，但尚不确定。