Wand Handan, Reddy Tarylee, Moodley Jayajothi, Naidoo Sarita, Ramjee Gita
Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
Biostatistics Unit, South African Medical Research Council, Durban, KZN, South Africa.
Arch Sex Behav. 2025 Feb;54(2):805-815. doi: 10.1007/s10508-024-03052-8. Epub 2025 Jan 13.
Over the past two decades, numerous HIV prevention trials have targeted thousands of young African women, aiming not only to reduce transmissions through biomedical interventions but also to promote safe sexual practices through intensive risk reduction sessions. The primary objective of this study was to review the impact of risk reduction sessions in HIV prevention trials conducted in Africa. We assessed changes in sexual behaviors among women enrolled in various biomedical intervention trials across the African region using both visual and quantitative evaluations. Meta-analysis techniques were used to estimate overall odds ratios. In a sub-group analysis, we also used semiparametric regression models to capture important features of the associations between sexual behaviors across the study visits with minimal statistical assumptions. Key time points were identified using the "zero-crossing" technique. Overall summary odds ratio (OR) for condom use in last sex was estimated as 2.21 (95% CI 2.06, 2.36). In our sub-group analysis, women who reported multiple sexual partners declined (adjusted odds ratios (aORs) range: 0.61-0.67) while condom use in last sex improved over time (aORs ranged from 2.22-to-2.60); 347(57%) women HIV seroconverted within the first 6-months which was the most crucial time point with substantial reductions in risky behaviors. This review highlights that the gradual cumulative effect of risk reduction sessions, rather than an immediate substantial impact, may have significant implications in clinical research settings. Effective and sustainable risk reduction programs should include biological components such as pre-exposure prophylaxis (PrEP) to reduce HIV transmission.
在过去二十年中，众多艾滋病毒预防试验针对数千名非洲年轻女性，不仅旨在通过生物医学干预减少传播，还通过强化风险降低课程促进安全性行为。本研究的主要目的是回顾在非洲进行的艾滋病毒预防试验中风险降低课程的影响。我们使用视觉和定量评估方法，评估了非洲地区参与各种生物医学干预试验的女性性行为的变化。采用荟萃分析技术估计总体比值比。在亚组分析中，我们还使用半参数回归模型，以最少的统计假设捕捉研究访视期间性行为之间关联的重要特征。使用“过零”技术确定关键时间点。上次性行为时使用避孕套的总体汇总比值比（OR）估计为2.21（95%置信区间2.06，2.36）。在我们的亚组分析中，报告有多个性伴侣的女性数量减少（调整后的比值比（aORs）范围：0.61 - 0.67），而上次性行为时使用避孕套的情况随时间有所改善（aORs范围为2.22至2.60）；347名（57%）女性在最初6个月内发生了艾滋病毒血清转化，这是风险行为大幅减少的最关键时间点。本综述强调，风险降低课程的逐渐累积效应而非立即产生的显著影响，可能在临床研究环境中具有重要意义。有效且可持续的风险降低计划应包括生物成分，如暴露前预防（PrEP）以减少艾滋病毒传播。
