Abstract
The aim of this review was to conduct a meta-analysis to assess the effectiveness of behavioural interventions to reduce HIV-related risk behaviours among key populations: people who inject drugs, female sex workers, men who have sex with men and transgender in Nepal over the last two decades. Using four electronic databases, we performed a systematic search of the literature on HIV interventions implemented in Nepal and published from January 2001 to December 2016. In addition, grey literature was also scrutinised for potential articles. The search focussed specifically on behavioural interventions (peer education and HIV testing services) targeted for key populations. Random-effects models were used to calculate the pooled odds ratio for dichotomous outcomes (condom use in last sex or unsafe injection practices), pooled HIV prevalence and subgroup analyses by age groups and epidemic zones in Nepal. Forty-three studies with 15,642 participants were included (people who inject drugs: 7105; men who have sex with men and transgender: 2637; female sex workers: 5900). Pooled prevalence showed a higher occurrence of HIV among people who inject drugs (12%) followed by men who have sex with men/transgender (5%) and female sex workers (2%) respectively. There was a significant increase in the odds of condom use among female sex workers, men who have sex with men and transgender who received peer education interventions in both informal and formal setting compared to those who did not. Similarly, the odds of condom use among female sex workers, men who have sex with men and transgender improved significantly among those who received HIV counselling and testing services as compared to those who did not use such services. Subgroup analyses also verified the effectiveness of these interventions for both young and adult key populations and across all three epidemic zones. However, none of the included interventions were found to be effective for reducing unsafe injection practices among people who inject drugs. HIV prevention interventions in Nepal have effectively reduced risky behaviours among female sex workers, men who have sex with men and transgender over the last two decades but not among people who inject drugs. This calls for continued implementation of existing efforts as well as for new interventions adapted to the needs of people who inject drugs.
Highlights
The world has committed to ending the HIV epidemic by 2030
For people who inject drugs (PWID), we found a pooled HIV prevalence of 11.9%, based on 22 studies conducted in three epidemic zones across the whole country between 2003 and 2015 (Table 1)
To the best of our knowledge, this is the first meta-analysis of the effect of behavioural interventions on HIV risk behaviours among key populations (FSW, PWID, men who have sex with men (MSM) and TG) in Nepal
Summary
The world has committed to ending the HIV epidemic by 2030. Accomplishments such as a decrease in AIDS-related mortality by 45% since its peak in 2005 and increase in people receiving antiretroviral therapy (ART) by one-third in just two years have inspired global confidence that this target is achievable[1]. The HIV epidemic in Nepal is concentrated, with nearly 60% of infections occurring in key populations. Secondary analysis of HIV prevalence surveys identified diverging trends in risk behaviours across local epidemic zones, which suggested the need for context-specific HIV prevention policies and activities[7]. This review aimed to address this gap by conducting a review of all available studies on behavioural interventions targeting at-risk populations for HIV in the context of Nepal. This review includes peer-driven interventions targeting key populations and HIV testing services, which are most commonly used in Nepal[16]. A lack of country-based information on the impact and quality of prevention programs poses challenges in development, implementation, and evaluation of HIV prevention programs This meta-analysis aimed to assess the effectiveness of available HIV-related behavioural interventions for key populations in Nepal. The pooled prevalence of HIV was estimated, including any differences in HIV risk behaviours by age and local epidemic zone
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