Sexual Risk Reduction for HIV-Infected Persons: A Meta-Analytic Review of -Positive Prevention- Randomized Clinical TrialsReport as inadecuate




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Background

Prevention 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.

Methods

RCTs 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.

Results

Lower 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.

Conclusions

Our 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.



Author: Lu Yin, Na Wang, Sten H. Vermund, Bryan E. Shepherd, Yuhua Ruan, Yiming Shao, Han-Zhu Qian

Source: http://plos.srce.hr/



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