Abstract
Behavioral interventions can prevent the transmission of HIV and sexually transmitted infections. This systematic review and meta-analysis assesses the effectiveness and quality of available evidence of HIV prevention interventions for people living with HIV in high-income settings. Searches were conducted in MEDLINE, EMBASE, PsycINFO, and CDC Compendium of Effective Interventions. Interventions published between January, 1998 and September, 2015 were included. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Forty-six articles and 63 datasets involving 14,096 individuals met inclusion criteria. Included articles were grouped by intervention type, comparison group and outcome. Few of these had high or moderate quality of evidence and statistically significant effects. One intervention type, group-level health education interventions, were effective in reducing HIV/STI incidence when compared to attention controls. A second intervention type, comprehensive risk counseling and services, was effective in reducing sexual risk behaviors when compared to both active and attention controls. All other intervention types showed no statistically significant effect or had low or very low quality of evidence. Given that the majority of interventions produced low or very low quality of evidence, researchers should commit to rigorous evaluation and high quality reporting of HIV intervention studies.
Highlights
HIV is a serious health issue in North America
While the estimated incidence of HIV in the United States and Canada has remained stable in recent years [1,2], among people living with HIV, there has been a marked increase in the diagnosis of other sexually transmitted infections (STIs), syphilis and gonorrhea [3]
This review aims to assess the effectiveness of behavioral HIV/STI prevention interventions among people living with HIV in high-income settings through quantitative synthesis of data from experimental studies
Summary
In the United States alone, over 1.2 million people are living with HIV, many of whom are unaware of their infection [1]. While the estimated incidence of HIV in the United States and Canada has remained stable in recent years [1,2], among people living with HIV, there has been a marked increase in the diagnosis of other sexually transmitted infections (STIs), syphilis and gonorrhea [3]. The prevalence of unprotected anal intercourse (UAI) among HIVpositive men who have sex with men (MSM) with either an unknown HIV-status or HIV-negative partner was 26% (95% CI 21-30%) [5]. Prevalence of UAI was even higher with HIV-positive partners (30%; 95% CI 25–36%) [5]
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