Structural and community-level interventions for increasing condom use to prevent the transmission of HIV and other sexually transmitted infections.

摘要: Background Community interventions to promote condom use are considered be a valuable tool reduce the transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). In particular, special emphasis has been placed on implementing such through structural changes, concept that implies public health actions aim improve society's modifications in context wherein health-related risk behavior takes place. This strategy attempts increase turn lower HIV STIs. Objectives To assess effects community-level for increasing both general high-risk populations incidence STI by comparing alternative strategies, or assessing compared with control. Search methods We searched Cochrane Central Register Controlled Trials (CENTRAL) (The Library, from 2007, Issue 1), as well MEDLINE, EMBASE, AEGIS ClinicalTrials.gov, January 1980 April 2014. We also handsearched proceedings international acquired syndrome (AIDS) conferences, major behavioral studies conferences focusing HIV/AIDS STIs. Selection criteria Randomized control trials (RCTs) featuring all following. 1. Community ('community' defined geographical entity, cities, counties, villages). 2. One more whose objective was use. These type can those improving accessibility, availability acceptability any given program/technology. 3. confirmed biological outcomes using laboratory testing. Data collection analysis Two authors independently screened selected relevant studies, conducted further bias assessment. assessed effect treatment pooling comparable characteristics quantified its size ratio. The clustering at community level addressed intra-cluster correlation coefficients (ICCs), sensitivity analysis carried out different design values. Main results We included nine (plus one study subanalysis) quantitative were Tanzania, Zimbabwe, South Africa, Uganda, Kenya, Peru, China, India Russia, comprising 75,891 participants, mostly including population (not population). main intervention promotion, distribution, both. general, groups did not receive active intervention. incomplete outcome data. In meta-analysis, there no clear evidence had an either seroprevalence seroincidence when controls: (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.69 1.19) prevalence (RR 1.02, CI 0.79 1.32). estimated similarly uncertain: Herpes simplex 2 (HSV-2) 0.76, 0.55 1.04); HSV-2 1.01, 0.85 1.20); syphilis 0.91, 0.71 1.17); gonorrhoea 1.16, 0.67 2.02); chlamydia 0.94, 0.75 1.18); trichomonas 1.00, 0.77 1.30). Reported increased experimental arm 1.20, 1.03 1.40). groups, number people reporting two sexual partners past year show decrease 0.78 1.04), but knowledge about STIs improved 1.15, 1.04 1.28, RR 1.23, 1.07 1.41, respectively). quality deemed moderate nearly key outcomes. Authors' conclusions There is prevent STIs. However, this conclusion should interpreted caution since our results have wide intervals may affected attrition bias. addition, it possible find RCTs which extended changes policies only apply developing nations, particularly Sub-Saharan region widely diverse.