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A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs.

ABSTRACT: To identify the mode of delivery, communicator, and content dimensions that make STI/HIV prevention interventions most successful at increasing condom use/protected sex or reducing STI/HIV incidence. A literature search for published meta-analyses of STI/HIV prevention interventions yielded 37 meta-analyses that had statistically tested the moderating effects of the dimensions. Significant and non-significant moderators from the coded dimensions were extracted from each meta-analysis. The most consistently significant moderators included matching the gender or ethnicity of the communicator to the intervention recipients, group targeting or tailoring of the intervention, use of a theory to underpin intervention design, providing factual information, presenting arguments designed to change attitudes, and providing condom skills and intrapersonal skills training. The absence of significant effects for intervention duration and expert delivery are also notable. The success of HIV/STI prevention interventions may be enhanced not only by providing skills training and information designed to change attitudes, but also by ensuring that the content is tailored to the target group and delivered by individuals of the same gender and ethnicity as the recipients.

SUBMITTER: Covey J

PROVIDER: S-EPMC4853449 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs.

Covey Judith J Rosenthal-Stott Harriet E S HE Howell Stephanie J SJ

Journal of behavioral medicine 20160130 3

To identify the mode of delivery, communicator, and content dimensions that make STI/HIV prevention interventions most successful at increasing condom use/protected sex or reducing STI/HIV incidence. A literature search for published meta-analyses of STI/HIV prevention interventions yielded 37 meta-analyses that had statistically tested the moderating effects of the dimensions. Significant and non-significant moderators from the coded dimensions were extracted from each meta-analysis. The most c ...[more]

PMID: 26831053

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Project description:OBJECTIVE:To establish the views and experiences of healthcare professionals in relation to interventions targeted at them to reduce unnecessary caesareans. DESIGN:Qualitative evidence synthesis. SETTING:Studies undertaken in high-income, middle-income and low-income settings. DATA SOURCES:Seven databases (CINAHL, MEDLINE, PsychINFO, Embase, Global Index Medicus, POPLINE and African Journals Online). Studies published between 1985 and June 2017, with no language or geographical restrictions. We hand-searched reference lists and key citations using Google Scholar. STUDY SELECTION:Qualitative or mixed-method studies reporting health professionals' views. DATA EXTRACTION AND SYNTHESIS:Two authors independently assessed study quality prior to extraction of primary data and authors' interpretations. The data were compared and contrasted, then grouped into summary of findings (SoFs) statements, themes and a line of argument synthesis. All SoFs were Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessed. RESULTS:17 papers were included, involving 483 health professionals from 17 countries (nine high-income, six middle-income and two low-income). Fourteen SoFs were identified, resulting in three core themes: philosophy of birth (four SoFs); (2) social and cultural context (five SoFs); and (3) negotiation within system (five SoFs). The resulting line of argument suggests three key mechanisms of effect for change or resistance to change: prior beliefs about birth; willingness or not to engage with change, especially where this entailed potential loss of income or status (including medicolegal barriers); and capacity or not to influence local community and healthcare service norms and values relating to caesarean provision. CONCLUSION:For maternity care health professionals, there is a synergistic relationship between their underpinning philosophy of birth, the social and cultural context they are working within and the extent to which they were prepared to negotiate within health system resources to reduce caesarean rates. These findings identify potential mechanisms of effect that could improve the design and efficacy of change programmes to reduce unnecessary caesareans. PROSPERO REGISTRATION NUMBER:CRD42017059455.

Project description:BACKGROUND:Rates of STIs continue to rise worldwide, and novel evidence-based interventions such as text messaging aimed at improving client services are needed. We conducted a meta-analysis to evaluate text messaging to support STI/HIV prevention and treatment interventions. METHODS:We included articles that reported findings from randomized controlled trials (RTCs) involving adults and youth who were at risk of acquiring (or who currently had) a STI and/or HIV, a text message and comparator intervention, and reported provided outcome data on adherence to STI/HIV treatments. Articles were excluded if they were not published in English. We only included studies that have full-text publications so certainty and risk of bias assessments could be performed. Eight databases were searched to retrieve articles published between 1996 and March 2017. The Cochrane risk of bias tool was used and certainty of the evidence was assessed using GRADE. Effect estimates were pooled using a random effects model. RESULTS:A total of 35 RCTs were found, 6 of which were considered at low risk of bias. Eight studies found an increased association using text messaging in appointments attended compared to standard care (OR 1.64, 95% CI 1.28 to 2.10). Participants receiving text messages had an increase in HIV testing compared to standard care (n?=?6; OR 1.73, 95% CI 1.39 to 2.15). Ten text messaging RCTs measuring adherence using micro-electro-mechanical systems (MEMS) pill counts has a non-significant association (OR 1.17, 95% CI 0.95-1.45) while five studies measuring adherence by self-report was found to be significant (OR 1.64, 95% CI 1.28-2.11). CONCLUSIONS:The effectiveness of text message interventions is equivocal. While text messaging has the potential to enhance the delivery of STI/HIV interventions, program planners are encouraged to evaluate any SMS intervention to ensure it is achieving the desired result. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42013006503.

Dataset Information

A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs.

Publications

A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs.

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