Efficacy of HIV/STI behavioral interventions for heterosexual African American men in the United States: a meta-analysis

This meta-analysis estimates the overall efficacy of HIV prevention interventions to reduce HIV sexual risk behaviors and sexually transmitted infections (STIs) among heterosexual African American men. A comprehensive search of the literature published during 1988–2008 yielded 44 relevant studies. Interventions significantly reduced HIV sexual risk behaviors and STIs. The stratified analysis for HIV sexual risk behaviors indicated that interventions were efficacious for studies specifically targeting African American men and men with incarceration history. In addition, interventions that had provision/referral of medical services, male facilitators, shorter follow-up periods, or emphasized the importance of protecting family and significant others were associated with reductions in HIV sexual risk behaviors. Meta-regression analyses indicated that the most robust intervention component is the provision/referral of medical services. Findings indicate that HIV interventions for heterosexual African American men might be more efficacious if they incorporated a range of health care services rather than HIV/STI-related services alone

Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998–2007

This systematic review examines the overall efficacy of U.S. and international-based structural-level condom distribution interventions (SLCDIs) on HIV risk behaviors and STIs and identifies factors associated with intervention efficacy. A comprehensive literature search of studies published from January 1988 through September 2007 yielded 21 relevant studies. Significant intervention effects were found for the following outcomes: condom use, condom acquisition/condom carrying, delayed sexual initiation among youth, and reduced incident STIs. The stratified analyses for condom use indicated that interventions were efficacious for various groups (e.g., youth, adults, males, commercial sex workers, clinic populations, and populations in areas with high STI incidence). Interventions increasing the availability of or accessibility to condoms or including additional individual, small-group or community-level components along with condom distribution were shown to be efficacious in increasing condom use behaviors. This review suggests that SLCDIs provide an efficacious means of HIV/STI prevention

Developing a Comprehensive Search Strategy for Evidence Based Systematic Reviews

Objective ‐ Within the health care field it becomes ever more critical to conduct systematic reviews of the research literature to guide programmatic activities, policy‐making decisions, and future research. Conducting systematic reviews requires a comprehensive search of behavioural, social, and policy research to identify relevant literature. As a result, the validity of the systematic review findings and recommendations is partly a function of the quality of the systematic search of the literature. Therefore, a carefully thought out and organized plan for developing and testing a comprehensive search strategy should be followed. This paper uses the HIV/AIDS prevention literature to provide a framework for developing, testing, and conducting a comprehensive search strategy looking beyond RCTs.Methods ‐ Comprehensive search strategies, including automated and manual search techniques, were developed, tested, and implemented to locate published and unpublished citations in order to build a database of HIV/AIDS and sexually transmitted diseases (STD) literature. The search incorporated various automated and manual search methods to decrease the chance of missing pertinent information. The automated search was implemented in MEDLINE, EMBASE,PsycINFO, Sociological Abstracts and AIDSLINE. These searches utilized both index terms as well as keywords including truncation, proximity, and phrases. The manual search method includes physically examining journals (hand searching), reference list checks, and researching key authors.Results ‐ Using automated and manual search components, the search strategy retrieved 17,493 articles about prevention of HIV/AIDS and STDs for the years 1988‐2005. The automated search found 91%, and the manual search contributed 9% of the articles reporting on HIV/AIDS or STD interventions with behavioural/biologic outcomes. Among the citations located with automated searches, 48% were found in only one database (20% MEDLINE, 18% PsycINFO, 8% EMBASE, 2% Sociological Abstracts).Conclusions ‐ Development of a comprehensive review of the literature requires searching multiple databases and methods of manual searching in order to locate all relevant citations. Understanding the project needs, recognizing the limitations and strengths of specific electronic databases, and being aware of other methods for developing and refining a search are vital in planning an effective and comprehensive search strategy. Reporting standards for literature searches as part of the broader push for procedurally transparent and reproducible systematic reviews is not only advisable, but good evidence based practice

Estimating the number of persons who inject drugs in the united states by meta-analysis to calculate national rates of HIV and hepatitis C virus infections.

BACKGROUND: Injection drug use provides an efficient mechanism for transmitting bloodborne viruses, including human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Effective targeting of resources for prevention of HIV and HCV infection among persons who inject drugs (PWID) is based on knowledge of the population size and disparity in disease burden among PWID. This study estimated the number of PWID in the United States to calculate rates of HIV and HCV infection. METHODS: We conducted meta-analysis using data from 4 national probability surveys that measured lifetime (3 surveys) or past-year (3 surveys) injection drug use to estimate the proportion of the United States population that has injected drugs. We then applied these proportions to census data to produce population size estimates. To estimate the disease burden among PWID by calculating rates of disease we used lifetime population size estimates of PWID as denominators and estimates of HIV and HCV infection from national HIV surveillance and survey data, respectively, as numerators. We calculated rates of HIV among PWID by gender-, age-, and race/ethnicity. RESULTS: Lifetime PWID comprised 2.6% (95% confidence interval: 1.8%-3.3%) of the U.S. population aged 13 years or older, representing approximately 6,612,488 PWID (range: 4,583,188-8,641,788) in 2011. The population estimate of past-year PWID was 0.30% (95% confidence interval: 0.19 %-0.41%) or 774,434 PWID (range: 494,605-1,054,263). Among lifetime PWID, the 2011 HIV diagnosis rate was 55 per 100,000 PWID; the rate of persons living with a diagnosis of HIV infection in 2010 was 2,147 per 100,000 PWID; and the 2011 HCV infection rate was 43,126 per 100,000 PWID. CONCLUSION: Estimates of the number of PWID and disease rates among PWID are important for program planning and addressing health inequities

Estimating the Number of Heterosexual Persons in the United States to Calculate National Rates of HIV Infection

<div><p>Background</p><p>This study estimated the proportions and numbers of heterosexuals in the United States (U.S.) to calculate rates of heterosexually acquired human immunodeficiency virus (HIV) infection. Quantifying the burden of disease can inform effective prevention planning and resource allocation.</p><p>Methods</p><p>Heterosexuals were defined as males and females who ever had sex with an opposite-sex partner and excluded those with other HIV risks: persons who ever injected drugs and males who ever had sex with another man. We conducted meta-analysis using data from 3 national probability surveys that measured lifetime (ever) sexual activity and injection drug use among persons aged 15 years and older to estimate the proportion of heterosexuals in the United States population. We then applied the proportion of heterosexual persons to census data to produce population size estimates. National HIV infection rates among heterosexuals were calculated using surveillance data (cases attributable to heterosexual contact) in the numerators and the heterosexual population size estimates in the denominators.</p><p>Results</p><p>Adult and adolescent heterosexuals comprised an estimated 86.7% (95% confidence interval: 84.1%-89.3%) of the U.S. population. The estimate for males was 84.1% (CI: 81.2%-86.9%) and for females was 89.4% (95% CI: 86.9%-91.8%). The HIV diagnosis rate for 2013 was 5.2 per 100,000 heterosexuals and the rate of persons living with diagnosed HIV infection in 2012was 104 per 100,000 heterosexuals aged 13 years or older. Rates of HIV infection were >20 times as high among black heterosexuals compared to white heterosexuals, indicating considerable disparity. Rates among heterosexual men demonstrated higher disparities than overall population rates for men.</p><p>Conclusions</p><p>The best available data must be used to guide decision-making for HIV prevention. HIV rates among heterosexuals in the U.S. are important additions to cost effectiveness and other data used to make critical decisions about resources for prevention of HIV infection.</p></div