Abstract
BackgroundAs high stigmatization of HIV and relatively low knowledge of HIV transmission and prevention measures persist in Sub-Saharan Africa, the improvement of HIV-related knowledge, and the evaluation of which types of interventions are most effective in this regard, is an important aspect of further prevention efforts. In addition, it is of interest to assess whether improvements in HIV-related knowledge may actually lead to increased engagement in preventive behaviours and ultimately lower HIV transmission. This study therefore aims to systematically review and meta-analyse the evidence for the effect of HIV-related knowledge interventions on 1) the improvement of HIV-related knowledge, 2) subsequent risk reduction behaviour (condom use), 3) lower incidence of HIV infection.MethodsA literature search was conducted using the Embase and Medline databases, returning 746 after duplicate removal. Following abstract and full-text screening, 36 studies were ultimately included in the final review. Meta-analyses were conducted in R, using random-effects models, for the HIV-related knowledge, condom use, and HIV incidence outcomes, where sufficient data were available.ResultsInterventions assessed in the reviewed studies varied, including computer-based interventions, mass media campaigns, and peer education interventions. The interventions were generally found to be effective at improving HIV-related knowledge in the target population, with 10 studies reporting improved knowledge of risk reduction through condom use in the intervention group (out of 11 studies reporting data for this outcome), with 6 reporting these differences as significant (p < 0.05). Regarding knowledge of transmission routes, studies assessing peer education interventions often reported significant improvements in the intervention group. Meta-analysis results showed significantly higher odds among the intervention groups of correct knowledge of: risk reduction through condom use (OR: 3.09, 95%CI: 1.83–5.22, p < 0.0001), sexual transmission of HIV (OR: 5.86, 95%CI: 2.65–12.97, p < 0.001) and transmission through sharps (OR: 4.35, 95%CI = 3.21–5.90, p < 0.001), but non-significantly lower odds of HIV infection (OR: 0.97, 95%CI: 0.66–1.41, p = 0.854).ConclusionPeer-education-based interventions appear to be particularly effective in facilitating the uptake of HIV-related knowledge, particularly pertaining to transmission routes. There is some evidence that improved knowledge of HIV transmission and prevention facilitates increased subsequent engagement in preventive measures, although this requires further exploration.Trial registrationPROSPERO Number: CRD42018090600
Highlights
As high stigmatization of Human Immunodeficiency Virus (HIV) and relatively low knowledge of HIV transmission and prevention measures persist in Sub-Saharan Africa, the improvement of HIV-related knowledge, and the evaluation of which types of interventions are most effective in this regard, is an important aspect of further prevention efforts
Interventions based on theories of behaviour change have been commonly used in interventions aiming to improve HIV-related knowledge, as it has been found that HIV education interventions are associated with a greater likelihood of subsequent adoption of preventive behaviours when implemented in combination with behaviour change elements [18]
Following 175 exclusions at full-text level (mainly due to not reporting raw data on the outcomes of interest (n = 51), or not reporting on a HIV-related knowledge intervention (n = 37)) 36 studies were included in the final review
Summary
As high stigmatization of HIV and relatively low knowledge of HIV transmission and prevention measures persist in Sub-Saharan Africa, the improvement of HIV-related knowledge, and the evaluation of which types of interventions are most effective in this regard, is an important aspect of further prevention efforts. Efforts towards improving HIV-related knowledge in Sub-Saharan Africa have encompassed a wide variety of intervention types and methods of disseminating HIV-related information, such as peer education [7,8,9], game-based education [10], skill-building interventions [11, 12], and mass media campaigns [13] Many such interventions have drawn on various theoretical frameworks, such as social cognitive theory [8, 14], the theory of planned behaviour [12], and the theory of reasoned action [15, 16]. Interventions based on theories of behaviour change have been commonly used in interventions aiming to improve HIV-related knowledge, as it has been found that HIV education interventions are associated with a greater likelihood of subsequent adoption of preventive behaviours when implemented in combination with behaviour change elements [18]
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