Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

Abstract Background: Peer education has become a strategy for health promotion among high-risk groups for HIV infection worldwide. However, the extent to which peer education could have an impact on HIV prevention or the long-term effect of this impact is still unknown. This study thus quantifies the impact of peer education over time among high-risk HIV groups globally. Method: Following the PRISMA guidelines, a systematic review and meta-analysis was used to assess the effects and duration of peer education. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on high-risk HIV groups were reviewed. Pooled effects were calculated and the sources of heterogeneity were explored using meta-regression and subgroup analysis. Results: A total of 60 articles with 96484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among overall high risk groups (OR: 0.64; 95%CI: 0.47-0.87). Peer education can promote HIV testing (OR=3.19; 95%CI:2.13,4.79) and condom use (OR=2.66, 95% CI: 2.11-3.36) while reduce equipment sharing (OR=0.50; 95%CI:0.33,0.75) and unprotected sex (OR=0.82; 95%CI: 0.72-0.94). Time trend analysis revealed that peer education had a consistent effect on behavior change for over 24 months and the different follow-up times were a source of heterogeneity. Conclusion: Our study shows that peer education is an effective tool with long-term impact for behavior change among high-risk HIV groups worldwide. Low and middle-income countries are encouraged to conduct large-scale peer education.

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Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

BMC Infectious Diseases ◽

10.1186/s12879-020-05003-9 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Jiayu He ◽

Ying Wang ◽

Zhicheng Du ◽

Jing Liao ◽

Na He ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Hiv Prevention ◽

Meta Analysis ◽

Peer Education ◽

Risk Groups

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Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

10.21203/rs.2.13653/v1 ◽

2019 ◽

Author(s):

Jiayu He ◽

Ying Wang ◽

Zhicheng Du ◽

Na He ◽

Yuantao Hao

Keyword(s):

Systematic Review ◽

High Risk ◽

Hiv Testing ◽

Large Scale ◽

Meta Analysis ◽

Peer Education ◽

Risk Groups ◽

Unprotected Sex ◽

Cochrane Library ◽

Better Than

Abstract Background Peer education has become a strategy for health promotion among HIV groups at high-risk worldwide. However, the quantitative effect and its duration of peer education on preventing HIV is still unknown.Method A systematic review and meta-analysis was adopted to assess the effects and its duration of peer education, following the PRISMA guidelines. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on HIV high-risk groups were reviewed. Pooled effects were calculated and the heterogeneity source were explored using meta-regression and subgroup analysis.Results A total of 60 articles with 96484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among high risk groups overall (OR: 0.64; 95%CI: 0.47-0.87). Peer education can promote HIV testing (OR=3.19; 95%CI:2.13,4.79) better than condom use (OR=2.66, 95% CI: 2.11-3.36) and can reduce equipment sharing (OR=0.50; 95%CI:0.33,0.75) better than unprotected sex (OR=0.82; 95%CI: 0.72-0.94). Time trend analysis showed a persistent effect of peer education and the different follow-up time was a source of heterogeneity.Conclusion Peer education is persistently effective for changing behaviors among high-risk groups worldwide, especially for the behaviors of HIV testing and equipment sharing. Low and middle income countries are encouraged to conduct peer education at a large scale.

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Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited

International Journal of STD & AIDS ◽

10.1258/0956462001915480 ◽

2000 ◽

Vol 11 (3) ◽

pp. 137-142 ◽

Cited By ~ 49

Author(s):

Nigel O'Farrell ◽

Matthias Egger

Keyword(s):

Systematic Review ◽

High Risk ◽

Hiv Infection ◽

Male Circumcision ◽

Odds Ratio ◽

Meta Analysis ◽

Risk Groups ◽

Sub Saharan Africa ◽

Effect Model ◽

Increased Risk

There is debate on the role of male circumcision in HIV transmission. Most case-control and cohort studies from Africa have shown an association between a lack of circumcision and an increased risk of HIV infection in men. The evidence is conflicting, however, with cross-sectional surveys from Tanzania and Rwanda either showing no relationship or an association in the opposite direction. A recent review and meta-analysis of the literature concluded that the risk of HIV infection was lower in uncircumcised men (combined odds ratio 0.94, 95% confidence interval 0.89 to 0.99). However, the analysis was performed by simply pooling the data from 33 diverse studies, which is an inappropriate method for combining studies. We re-analysed the data, stratifying by study, and found that an intact foreskin was associated with an increased risk of HIV infection: combined odds ratio 1.43 (1.32 to 1.54) with a fixed effect model and 1.67 (1.25 to 2.24) with a random effect model. There was significant between-study heterogeneity (P < 0.0001) which was partly explained by stronger associations in studies in high-risk groups. The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay.

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Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054706 ◽

2020 ◽

pp. sextrans-2020-054706

Author(s):

Meng Yin Wu ◽

Hui Zi Gong ◽

Kui Ru Hu ◽

He-yi Zheng ◽

Xia Wan ◽

...

Keyword(s):

Systematic Review ◽

Relative Risk ◽

High Risk ◽

Meta Analysis ◽

Risk Groups ◽

Hiv Incidence ◽

Syphilis Infection ◽

High Risk Populations ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition

ObjectivesCo-infection of syphilis and HIV remains hard to manage and its morbidity shows a rising tendency. Syphilis has been associated with increased risk of HIV acquisition in high-risk groups, especially in men who have sex with men (MSM). This systematic review and meta-analysis estimates the effect of syphilis infection on subsequent HIV acquisition, and assesses its difference between MSM and other high-risk populations.MethodsFive electronic databases were searched for literature published to 21 September 2019 without language restrictions. Longitudinal studies that enrolled key populations to compare the incidence of HIV with and without syphilis exposure were included. We used a random-effects model to estimate the effect of syphilis infection on HIV acquisition among high-risk populations, which include MSM, sex workers, serodiscordant couples, people who inject drugs and attendees of STD clinics.ResultsA total of 17 cohorts and 5 case-control studies involving 65 232 participants were included. HIV incidence showed a two-time increase after syphilis exposure, compared with a control group (relative risk (RR) 2.67 (95% CI 2.05 to 3.47); p<0.05 for prevalence; RR 3.21 (95% CI 2.26 to 4.57); p=0.419 for incidence). No significant differences were observed between MSM and other high-risk groups in syphilis infection prevalence (RR 2.60 (95% CI 1.78 to 3.80); p<0.05 vs RR, 2.98 (95% CI 2.15 to 4.14); p<0.05; ratio of relative risk 0.76 (95% CI 0.49 to 1.17)).ConclusionsSyphilis infection increases the risk of HIV acquisition in high-risk populations. There is no evidence to suggest MSM are at greater risk than other high-risk populations. Prompt diagnosis, timely treatment, preventive interventions against syphilis infection would be a worthwhile investment for reducing HIV incidence. Strategies to combat stigma and discrimination targeted at MSM are pragmatically needed.

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Urgent Carotid Endarterectomy for Patients with Unstable Symptoms: Systematic Review and Meta-Analysis of Outcomes

Vascular ◽

10.2310/6670.2009.00038 ◽

2009 ◽

Vol 17 (5) ◽

pp. 243-252 ◽

Cited By ~ 6

Author(s):

Benjamin O. Patterson ◽

Peter J. Holt ◽

Robert J. Hinchliffe ◽

Matt M. Thompson ◽

Ian M. Loftus

Keyword(s):

Systematic Review ◽

High Risk ◽

Confidence Interval ◽

Carotid Endarterectomy ◽

Odds Ratio ◽

Meta Analysis ◽

Long Term Results ◽

Current Evidence ◽

Ischemic Attack

Current evidence suggests that carotid endarterectomy (CEA) performed within 2 weeks of symptoms produces better long-term results than if it is delayed. Urgent endarterectomy following unstable presentations such as crescendo transient ischemic attack (cTIA) or progressive stroke has been associated with variable results. The evidence for this treatment strategy required reviewing. A systematic review of articles related to urgent CEA between 1980 and 2008 was performed. For cTIA, there was an odds ratio of 5.6 (95% confidence interval 3.3–9.7, p ≤ .0001) for combined stroke or death compared with surgery for “standard” indications. For unstable stroke, the odds ratio was 5.5 (95% confidence interval 3.1–9.3, p ≤ .0001). Patients with unstable neurologic presentations are at higher risk of complications if operated on urgently. Clearer definitions would help more precise patient selection to avoid inadvertently operating on patients with an unacceptably high risk of poor outcome.

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Late diagnosis of human immunodeficiency virus infections in high-risk groups in Karachi, Pakistan

International Journal of STD & AIDS ◽

10.1177/0956462418785264 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1400-1406

Author(s):

Zahra Hasan ◽

Sharaf Shah ◽

Rumina Hasan ◽

Shoaib Rao ◽

Manzoor Ahmed ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

High Risk ◽

Early Diagnosis ◽

Hiv Infection ◽

Hiv Infections ◽

Risk Groups ◽

Newly Diagnosed ◽

Immunodeficiency Virus ◽

Hiv 1

Human immunodeficiency virus (HIV) infection prevalence in Pakistan has been increasing in high-risk groups, including people who inject drugs (PWID) and transgender hijra sex workers (TG-HSWs) nationwide. Effective control of HIV requires early diagnosis of the infection. We investigated recency of HIV infections in newly-diagnosed cases in PWID and TG-HSWs. This was an observational study with convenience sampling. Overall, 210 HIV-positive subjects comprising an equal number of PWID and TG-HSWs were included. Antibody avidity was tested using the Maxim HIV-1 Limiting Antigen Avidity (LAg) EIA (Maxim Biomedical, Inc. Rockville, Maryland, USA). The mean age of study subjects was 29.5 years: PWID, 28.5 years and TG-HSWs, 30.4 years. Study subjects were married, 27%, or unmarried. Eighteen percent of individuals had recently-acquired HIV infections: 19% of PWID and 17% of TG-HSWs. Eighty-two percent of individuals had long-term HIV infections: 81% of PWID and 83% of TG-HSWs. This is the first study identification of recent HIV-1 infections in Pakistan. We show that most newly-diagnosed HIV patients in the high-risk groups studied had long-term infections. There is an urgent need for intervention in these groups to facilitate early diagnosis and treatment of HIV infection to reduce transmission in Pakistan.

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