School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia.
Health Systems Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.
BMC Infect Dis. 2022 Aug 8;22(1):679. doi: 10.1186/s12879-022-07649-z.
BACKGROUND: Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade. METHODS: The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015's Determinant Framework. RESULTS: Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support). CONCLUSION: This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.
背景:旨在减少危险性行为的干预措施被认为是避免人类免疫缺陷病毒(HIV)感染的重要策略,因为青年(15-24 岁)继续面临感染该疾病的风险。为了提高干预的成功率,需要全面了解针对青年的干预措施的障碍和促进因素。然而,目前缺乏对定量和定性研究的系统综述,无法全面识别和综合世界各地减少青年危险性行为的 HIV 预防干预措施的障碍和促进因素。本综述旨在根据过去十年发表的原始同行评议研究,确定并综合全球范围内减少青年危险性行为的 HIV 预防干预措施的障碍和促进因素。
方法:采用乔安娜·布里格斯研究所(Joanna Briggs Institute)混合方法系统综述方法和首选系统综述和荟萃分析报告项目(Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines)指南指导本综述。检索了九个电子数据库、联合国艾滋病规划署和世界卫生组织网站、以及关于减少青年危险性行为的 HIV 预防干预措施的障碍和促进因素的系统综述的参考文献列表,以查找符合条件的文章。符合纳入标准的研究进行了质量评估和数据提取。使用主题综合分析方法对研究结果进行了分析,并以 Nilsen 2015 年的决定因素框架为基础。
结果:共有 13 项研究符合纳入标准,其中包括 8 项定性研究、4 项定量研究和 1 项混合方法研究。确定了五个决定因素框架领域的多个障碍和促进因素。大多数障碍属于背景特征领域(例如,性别偏见规范)。下一组重要的障碍出现在最终用户特征领域(例如,关系破裂的恐惧)。就促进因素而言,大多数属于促进实施策略领域的特征(例如,以保真度实施干预)和最终用户领域的特征(例如,对性传播感染或怀孕的恐惧)。下一组常见的促进因素出现在背景特征领域(例如,家庭支持)。
结论:本综述确定了减少青年危险性行为的 HIV 预防干预措施的几个多层次障碍和促进因素。需要采取多层次和组合方法来解决这些因素,提高干预的成功率。
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