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多种行为HIV 干预措施对地区劣势的影响:综合征分析。

The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics.

机构信息

Annenberg School for Communication, University of Pennsylvania.

Department of Psychology, University of Illinois Urbana-Champaign.

出版信息

J Consult Clin Psychol. 2023 Oct;91(10):574-595. doi: 10.1037/ccp0000827. Epub 2023 Jul 6.


DOI:10.1037/ccp0000827
PMID:37410398
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10527151/
Abstract

OBJECTIVE: Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV) infection, delayed HIV diagnosis, and unfavorable HIV-treatment outcomes. HIV interventions targeting single behaviors (e.g., testing) in these populations have shown to be efficacious at producing behavioral and clinical change but have been unable to eliminate the social health disparities associated with syndemics (i.e., a set of connected risks, interacting synergistically, and contributing to excess burden of disease in a population). METHOD: This meta-analysis of 331 reports (clusters; number of effect sizes [] = 1,364) assessed whether multiple-behavior interventions that target clusters of syndemic risks are more efficacious for those in disadvantaged regions and social groups. RESULTS: Across the board, multiple-behavior interventions were more efficacious than single-behavior ones as well as passive control groups among samples from countries with lower log gross domestic product (GDP), lower Human Development Index (HDI), and lower Healthcare Access and Quality (HAQ) Index. CONCLUSIONS: Within the United States, the efficacy of multiple-behavior interventions was similar across different levels of representation of racial/ethnic and sexual minorities. The analyses used robust variance estimation with small-sample corrections to assess the differential effects of multiple-behavior interventions and Egger Sandwich test with the multilevel meta-analysis approach to detect selection biases. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

摘要

目的:包括发展中国家居民以及美国的少数族裔和性少数群体在内的弱势群体,在艾滋病毒(HIV)感染、HIV 诊断延迟以及不利的 HIV 治疗结果方面承受着不成比例的负担。针对这些人群的单一行为(例如检测)的 HIV 干预措施已被证明在产生行为和临床改变方面是有效的,但未能消除与综合征(即一组相互关联的风险,协同作用,导致人群中疾病负担增加)相关的社会健康差异。

方法:对 331 份报告(簇;效应大小数量 [] = 1364)进行了荟萃分析,评估了针对综合征风险簇的多行为干预措施在处于弱势地区和社会群体中的人群中是否更有效。

结果:总的来说,多行为干预措施在来自国内生产总值(GDP)较低、人类发展指数(HDI)较低和医疗保健获取和质量(HAQ)指数较低的国家的样本中,比单一行为干预措施和被动对照组更有效。

结论:在美国,不同种族/族裔和性少数群体代表性水平的多行为干预措施的效果相似。分析使用了具有小样本校正的稳健方差估计来评估多行为干预措施的差异效果,并使用多层荟萃分析方法的 Egger 三明治检验来检测选择偏差。(PsycInfo 数据库记录(c)2023 APA,保留所有权利)。

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本文引用的文献

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[2]
HIV and mental health services for female sex workers.

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[3]
Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men.

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[4]
The syndemic effects of adverse mental health conditions and polysubstance use on being at risk of clinical depression among marginally housed and homeless transitional age youth living in San Francisco, California.

PLoS One. 2022

[5]
High levels of mild to moderate depression among men who have sex with men and transgender women in Lima, Peru: implications for integrated depression and HIV care.

AIDS Care. 2022-12

[6]
Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019.

Lancet HIV. 2021-10

[7]
Complex solutions for a complex problem: A meta-analysis of the efficacy of multiple-behavior interventions on change in outcomes related to HIV.

Health Psychol. 2021-9

[8]
Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States.

Adv Ther. 2021-9

[9]
The effect of a cluster-randomized controlled trial on lifestyle behaviors among families at risk for developing type 2 diabetes across Europe: the Feel4Diabetes-study.

Int J Behav Nutr Phys Act. 2021-7-1

[10]
Meta-analysis with Robust Variance Estimation: Expanding the Range of Working Models.

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