Sexual Risk Reduction for HIV-Infected Persons: A Meta-Analytic Review of “Positive Prevention” Randomized Clinical Trials

Abstract

BackgroundPrevention intervention trials have been conducted to reduce risk of sexual transmission among people living with HIV/AIDS (PLWHA), but the findings were inconsistent. We performed a systematic review and meta-analysis to evaluate overall efficacy of prevention interventions on unprotected vaginal or anal intercourse (UVAI) among PLWHA from randomized clinical trials (RCTs).MethodsRCTs of prevention interventions among PLWHA published as of February 2012 were identified by systematically searching thirteen electronic databases. The primary outcome was UVAI. The difference of standardized mean difference (SMD) of UVAI between study arms, defined as effect size (ES), was calculated for each study and then pooled across studies using standard meta-analysis with a random effects model.ResultsLower likelihood of UVAI was observed in the intervention arms compared with the control arms either with any sexual partners (mean ES: −0.22; 95% confidence interval [CI]: −0.32, −0.11) or with HIV-negative or unknown-status sexual partners (mean ES and 95% CI: −0.13 [−0.22, −0.04]). Short-term efficacy of interventions with ≤10 months of follow up was significant in reducing UVAI (1–5 months: −0.27 [−0.45, −0.10]; 6–10 months: −0.18 [−0.30, −0.07]), while long-term efficacy of interventions was weaker and might have been due to chance (11–15 months: −0.13 [−0.34, 0.08]; >15 months: −0.05 [−0.43, 0.32]).ConclusionsOur meta-analyses confirmed the short-term impact of prevention interventions on reducing self-reported UVAI among PLWHA irrespective of the type of sexual partner, but did not support a definite conclusion on long-term effect. It is suggested that booster intervention sessions are needed to maintain a sustainable reduction of unprotected sex among PLWHA in future risk reduction programs.

Effects of integrated interventions on transmission risk and care continuum outcomes in persons living with HIV

“…Our findings show that integrated interventions are effective in reducing sex without condoms and potentially improve medication adherence behavior and undetectable viral load. The overall intervention effects on sex without condoms (OR, 0.74), medication adherence (OR, 1.35), and undetectable viral load (OR, 1.46) observed in this meta-analysis were comparable to the magnitude of effect sizes observed in previously published meta-analyses of RCTs for PLWH (sex without condoms: OR, 0.57 [8]; sex without condoms with at-risk partners: OR, 0.79 [11]; medication adherence: OR, 1.50 [16]; undetectable viral load: OR, 1.25 [16]). Results indicate no evidence that integrated interventions have effects on changing the number of sex partners, STD, needle sharing, injection drug use, retention in HIV care, or being on ART.…”

HIV/STI prevention interventions: A systematic review and meta-analysis

“…Within a landscape of limited public health funding, the findings of the present review can be used as a tool to support public health decisionmaking by assisting in the prioritization and allocation of funds for HIV prevention strategies. While other systematic reviews have been conducted on this topic, this review stands out in its use of the CDC classifications of behavioral interventions and GRADE to summarize the quality of available evidence, as well as its assessment of outcome measures such as HIV/STI incidence and knowledge, attitudes and beliefs, in addition to commonly reported sexual risk behavioral [ 4 , 7 , 8 ].…”

“…The Compendium identifies “evidence-based behavioral interventions proven to reduce HIV risk” [ 6 ], however, it does not quantitatively synthesize data across studies or assess the quality of available evidence [ 6 ]. Unlike previously conducted systematic reviews and meta-analyses [ 4 , 7 , 8 ], the present review stands out in three ways: (1) the use of the CDC classifications of behaviroal HIV interventions; (2) the use of GRADE to summarize the quality of available evidence; and (3) the assessment of outcome measures beyond sexual risk behaviors.…”

Substance use and HIV-risk behaviors among HIV-positive men who have sex with men in China: repeated measures in a cohort study design

“…Perhaps alcohol-use behaviors dominated the intervention effects, inhibiting MSM’s perceived risks of having sex with seropositive partners. It is also possible that HIV-positive MSM employed a “serosorting” strategy by having condomless sex with seropositive partners (Kalichman et al, 2001; Ruan et al, 2011; Yin et al, 2014). Future studies will need to explore these possibilities explicitly to gain insight as to why an increasing trend of high-risk behavior is observed among alcohol users.…”