Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men

Abstract

Men who have sex with men (MSM) remain one of the groups most at risk of HIV. The growing evidence-base on behavioural HIV prevention interventions includes systematic review-level evidence, including reviews specific to MSM populations. Here, we provide an up-to-date review of these systematic reviews in which we examined the effectiveness of behavioural HIV prevention interventions among MSM. A systematic search of electronic databases, including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, PsycInfo, from January 2000 to October 2010, along with hand searches of the reference lists of retrieved documents were conducted. Inclusion criteria included: study design limited to systematic reviews and meta-analyses; methodological quality; and review to focus on MSM and behavioural interventions. A narrative synthesis was conducted. Across the four included meta-analyses (102 studies; 52 independent studies), there was strong and consistent evidence for group- and community-level interventions being associated with reductions in UAI (27–30% and 30%, respectively) and increases in condom use amongst MSM, but inconsistent evidence for the effectiveness of individual-level interventions. Skills-building, trained professionals delivering the training and theory-based interventions were also consistently effective. The inherent limitations of the review of review method within a changing health domain meant it was difficult to develop contemporary and directly transferable guidance to HIV prevention policy development. However, the analysis does demonstrate a need for a step change in the kinds of data that are collated in the development of future systematic reviews of HIV prevention interventions among MSM.

Keywords:

• men who have sex with men
• HIV/AIDS
• meta-analysis
• review
• behavioural interventions

Acknowledgements

This work was funded by NHS Health Scotland, as part of guideline development under Action 9 (HIV prevention evidence synthesis on MSM) of the HIV Action Plan 2009–2014. The authors would like to thank the guideline development group for their invaluable input throughout the project, and in particular Phil Eaglesham, Paul Flowers and Simon Ellis for their support and guidance. The views and opinions expressed are those of the authors and not NHS Health Scotland. Funding was provided by NHS Health Scotland. No ethical approval was required. Contributions: KL led the design and conduct of the review. Maggie Lawrence, Lisa Kidd, Sandi Cayless and Kerri McPherson devised and carried out the literature searches; Sandi Cayless, Karen Lorimer screened and quality appraised the literature; Sandi Cayless, Karen Lorimer, Kerri McPherson, Lisa Kidd and Flora Cornish were involved in data extraction; Karen Lorimer synthesised the data, wrote the first draft of this article and collated subsequent iterations. All authors approved the final version of the manuscript.