Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Int AIDS Soc. 2022 Mar;25(3):e25889. doi: 10.1002/jia2.25889.
INTRODUCTION: Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. METHODS: We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. RESULTS AND DISCUSSION: We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. CONCLUSIONS: Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
简介:艾滋病毒护理连续体中缺少男性。然而,在撒哈拉以南非洲,符合联合国艾滋病规划署 95-95-95 目标的男性比例在不同研究中差异很大。我们试图估计撒哈拉以南非洲地区每一项 95-95-95 目标中符合要求的男性比例,描述其异质性,并总结影响护理参与的定性证据。 方法:我们系统地检索了 2014 年 1 月 1 日至 2020 年 10 月 16 日期间发表的同行评审文章,包括 PubMed 和 Embase。我们纳入了年龄≥15 岁的男性参与者的研究,研究数据采集时间为 2009 年以后,并且报告了撒哈拉以南非洲地区至少一项 95-95-95 目标的研究。我们使用 DerSimonian-Laird 随机效应模型估计这些目标中符合要求的男性比例,按研究人群(例如,专门针对男男性行为者的研究与不专门针对男男性行为者的研究)、机构设置(医疗保健与社区场所)、地区(东部/南部非洲与西部/中部非洲)、结果测量(例如病毒载量抑制的阈值)、数据采集的中位年份(在 2017 年之前、期间或之后)和质量标准进行分层。使用元综合法总结了探索男性艾滋病毒护理参与障碍的定性研究的数据。 结果和讨论:我们筛选了 14896 篇研究,纳入了 129 项荟萃分析研究,汇总了数据采集期间的数据。47 项研究报告了关于知晓血清状况的知识,43 项研究报告了抗逆转录病毒治疗的使用情况,74 项研究报告了病毒抑制情况。大约一半的艾滋病毒感染者男性表示不知道自己的状况(0.49 [95% CI,0.41-0.58;范围,0.09-0.97])或未接受治疗(0.58 [95% CI,0.51-0.65;范围,0.07-0.97]),而超过四分之三的男性在接受治疗时达到了病毒抑制(0.79 [95% CI,0.77-0.81;范围,0.39-0.97])。估计值存在高度异质性,在研究人群、环境和结局方面存在差异。40 项研究的元综合确定了男性描述与参与艾滋病毒护理相关的风险的三个主要领域:感知社会规范、卫生系统挑战和贫困。 结论:需要进行社会心理和系统层面的干预,改变男性对社会规范的看法,改善对卫生系统的信任和可及性,并解决获得护理的费用问题,以更好地促使男性参与艾滋病毒检测和治疗,尤其是在艾滋病毒检测和治疗方面。
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