Policy Research Solutions LLC and University at Buffalo, Buffalo, NY, USA.
United Nations Children's Fund (UNICEF), New York, NY, USA.
BMC Public Health. 2024 Jan 20;24(1):239. doi: 10.1186/s12889-023-17565-9.
HIV remains a leading cause of death for adolescents and young people aged 10-24 years. HIV prevention requires multisectoral approaches that target adolescents and young people, addressing HIV risk pathways (e.g., transactional sex, gender-based violence, and school attendance) through bundled interventions that combine economic strengthening, health capabilities, and gender equality education. However, best practices are unknown because evidence on multisectoral programming targeted to adolescents and combining these components has not been systematically reviewed.
We conducted a systematic review to summarize the evidence on bundled interventions combining health and economic strengthening components for adolescents and young people and their effects on HIV/STI incidence and risk factors. We included studies from Africa published between 2005 and 2023, combining at least one economic strengthening and one health component, directed toward adolescents and young people aged 10-24 years. Included studies measured programmatic impacts on primary outcomes: HIV and STI incidence/prevalence; and mediators as secondary outcomes: sexual behaviours, sexual and reproductive health, school attendance, health-seeking behaviours, and violence. We conducted key word searches in PubMed, EMBASE, and Web of Science, imported titles/abstracts from the initial search, and reviewed them using the inclusion criteria. Full texts of selected articles were reviewed and information was extracted for analysis. Findings from the full texts identified were summarized.
We reviewed 58 studies, including 43 quantitative studies and 15 qualitative studies, evaluating 26 unique interventions. A majority of studies reviewed were conducted in Eastern and Southern Africa. Interventions reviewed showed a greater number of significant results in improving economic outcomes; mental health and psychosocial outcomes; sexual and reproductive health knowledge and services utilization; and HIV prevention knowledge and testing. They showed fewer significant results in improving outcomes related to HIV incidence/prevalence; sexual risk behaviours; gender-based violence; gender attitudes; education; STI incidence, prevalence and testing; and sexual debut.
Our review demonstrated the potential for bundled, multisectoral interventions for preventing HIV and facilitating safe transitions to adulthood. Findings have implications for designing HIV sensitive programmes on a larger scale, including how interventions may need to address multiple strata of the social ecological model to achieve success in the prevention of HIV and related pathways.
艾滋病毒仍然是导致 10-24 岁青少年和年轻人死亡的主要原因。艾滋病毒预防需要多部门办法，以青少年和年轻人为对象，通过结合经济增强、健康能力和性别平等教育的综合干预措施，解决艾滋病毒风险途径（例如，交易性性行为、基于性别的暴力和上学）。然而，由于针对青少年的多部门方案编制和结合这些组成部分的最佳实践尚不清楚，因此尚未对其进行系统审查。
我们进行了一项系统审查，以总结关于结合健康和经济增强组成部分的综合干预措施的证据，这些干预措施针对 10-24 岁的青少年和年轻人，以及它们对艾滋病毒/性传播感染发病率和风险因素的影响。我们纳入了 2005 年至 2023 年期间在非洲发表的研究，这些研究结合了至少一个经济增强和一个健康组成部分，针对 10-24 岁的青少年和年轻人。纳入的研究衡量了方案对主要结果的影响：艾滋病毒和性传播感染发病率/流行率；以及作为次要结果的中介：性行为、性健康和生殖健康、上学、卫生保健寻求行为和暴力。我们在 PubMed、EMBASE 和 Web of Science 中进行了关键词搜索，从最初的搜索中导入了标题/摘要，并使用纳入标准对其进行了审查。对选定文章的全文进行了审查，并提取了信息进行分析。总结了从全文中确定的发现。
我们审查了 58 项研究，其中包括 43 项定量研究和 15 项定性研究，评估了 26 项独特的干预措施。审查的大多数研究都是在东非和南非进行的。审查的干预措施在改善经济成果方面显示出更多的显著结果；心理健康和心理社会成果；性健康和生殖健康知识以及服务的利用；以及艾滋病毒预防知识和检测。它们在改善与艾滋病毒发病率/流行率相关的结果方面显示出较少的显著结果；性行为风险；基于性别的暴力；性别态度；教育；性传播感染发病率、流行率和检测；以及性初体验。
我们的审查表明，多部门综合干预措施在预防艾滋病毒和促进安全成年方面具有潜力。研究结果对在更大规模上设计艾滋病毒敏感方案具有影响，包括干预措施可能需要解决社会生态模型的多个层次，以在预防艾滋病毒和相关途径方面取得成功。
