Rodriguez Christofer A, Mitchell Jason W
Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
Mil Med. 2023 Jan 4;188(1-2):e100-e107. doi: 10.1093/milmed/usac018.
With the goal of maintaining mission readiness, the U.S. Department of Defense monitors a variety of health behaviors among its active duty military service members, including sexual health, HIV, and other sexually transmitted infections. Newer biomedical approaches to HIV prevention and care (e.g., Treatment as Prevention (TasP) via Pre-exposure Prophylaxis (PrEP) and undetectable = untransmissible of antiretroviral therapy (ART/U = U) have evolved over the last few years and are now available. However, the last systematic review on HIV prevention among military populations was published in 2005, calling for the need to provide an update on what HIV prevention research has been conducted with U.S. active duty service members.
PRISMA guidelines were followed to identify articles that met pre-determined eligibility criteria. Several electronic databases were searched, including PubMed. The review focused on HIV prevention research conducted with the U.S. Military (i.e., active duty service members). Inclusion criteria for articles centered on population (U.S. active duty service members aged 17 years and older), language (published in English), study focus (epidemiological, intervention), study design (descriptive, quasi-experimental, and experimental), date of publication, and research focus. Studies with a descriptive focus to understand HIV-related risk behaviors, use of prevention strategies (e.g., condoms, testing, PrEP), and prescribing practices for uptake of prevention strategies among U.S. military service members (i.e., by providers, uptake from nonproviders) were included. Studies that focused on intervening or changing HIV risk (i.e., interventions) among U.S. military service members were also included.
The findings in this review were reported based on the PRISMA guidelines. A total of 2,270 articles were identified through electronic databases. Of the 2,270 articles, 809 articles were removed for duplication. Titles and abstracts were reviewed for the remaining 1,461 articles. Of the 1,461 articles, 1,432 were excluded for not meeting the inclusion criteria. In total, 29 studies met the inclusion criteria and were included in this review. Studies were organized into 3 tables based on study focus and target population (e.g., active duty, U.S. Military service members who were providers vs. nonproviders).
The present systematic review describes 29 HIV prevention studies that have been conducted with active duty service members in the U.S. Military since 2000. Overall, most included studies were descriptive, epidemiological studies conducted with active duty service members who were not providers. There were few interventions that reported some success in improving prevention knowledge and condom use. None of the interventions included newer evidence-based strategies of TasP. Although some research had been conducted about PrEP, particularly with providers, there is a clear need for additional studies and interventions to include TasP, given the evidence base of these approaches for reducing acquisition and/or onward transmission of HIV.
为保持任务准备状态，美国国防部监测现役军人的多种健康行为，包括性健康、艾滋病毒及其他性传播感染。在过去几年中，预防和治疗艾滋病毒的新型生物医学方法（例如通过暴露前预防（PrEP）实现治疗即预防（TasP）以及抗逆转录病毒疗法的病毒载量不可测即不具传染性（ART/U = U））不断发展，现已可用。然而，上一次关于军人中艾滋病毒预防的系统评价发表于2005年，当时呼吁有必要更新关于对美国现役军人开展的艾滋病毒预防研究情况。
遵循PRISMA指南来识别符合预定纳入标准的文章。搜索了多个电子数据库，包括PubMed。该评价聚焦于对美国军队（即现役军人）开展的艾滋病毒预防研究。文章的纳入标准围绕人群（17岁及以上的美国现役军人）、语言（以英文发表）、研究重点（流行病学、干预）、研究设计（描述性、准实验性和实验性）、发表日期以及研究焦点。纳入了以描述为重点来了解与艾滋病毒相关的风险行为、预防策略的使用（例如避孕套、检测、PrEP）以及美国军人中预防策略的处方开具情况（即由提供者开具、从非提供者处获取）的研究。还纳入了聚焦于干预或改变美国军人中艾滋病毒风险（即干预措施）的研究。
本评价中的研究结果是根据PRISMA指南报告的。通过电子数据库共识别出2270篇文章。在这2270篇文章中，809篇因重复而被剔除。对其余1461篇文章的标题和摘要进行了审查。在这1461篇文章中，1432篇因不符合纳入标准而被排除。总共有29项研究符合纳入标准并被纳入本评价。根据研究重点和目标人群（例如现役军人、作为提供者与非提供者的美国军人）将研究整理成3个表格。
本系统评价描述了自2000年以来对美国军队现役军人开展的29项艾滋病毒预防研究。总体而言，大多数纳入研究是对非提供者身份的现役军人开展的描述性流行病学研究。很少有干预措施报告在提高预防知识和避孕套使用方面取得了一些成功。没有一项干预措施纳入TasP这一基于最新证据的策略。尽管已经开展了一些关于PrEP的研究，特别是针对提供者的研究，但鉴于这些方法在减少艾滋病毒感染和/或传播方面的证据基础，显然需要更多的研究和干预措施来纳入TasP。
