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Headline
Behaviour change interventions can reduce HIV-risk-related behaviour but their UK applicability is uncertain. A candidate intervention was developed for UK use but would need testing in a trial.
Abstract
Background:
Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited.
Objectives:
To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention.
Data sources:
All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014.
Review methods:
A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation.
Results:
Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from ‘goals and planning’ and ‘identity’ groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation.
Limitations:
There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity.
Conclusions:
Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention.
Future work:
There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity.
Study registration:
The study is registered as PROSPERO CRD42014009500.
Funding:
The National Institute for Health Research Health Technology Assessment programme.
Contents
- Plain English summary
- Scientific summary
- Chapter 1. Background and rationale
- The health problem
- Significance to the NHS
- Current guidelines for human immunodeficiency virus infection prevention among men who have sex with men
- Current service provision
- Overview of current possible approaches to human immunodeficiency virus infection risk reduction
- Existing evidence syntheses
- Rationale for current evidence synthesis
- Population factors
- Rationale for a focus on behaviour change techniques
- Rationale for a focus on the role of theory
- Rationale for a focus on modes of delivery
- Rationale for expert event
- Aims
- Objectives
- Chapter 2. Systematic narrative review and meta-analysis
- Chapter 3. Systematic review results
- Included studies
- Number and type of studies excluded
- Recruitment methods and eligibility criteria
- Outcome measures
- Nature of interventions and comparators
- Proximity to testing
- Behaviour change techniques utilised within interventions and controls
- Behaviour change techniques unique to interventions when removing behaviour change techniques shared with control groups
- The use of theory within selected interventions
- Risk of bias
- Intervention fidelity
- Assessment of effectiveness
- Risk-related behaviour outcomes
- Other reported key outcomes
- Exploratory meta-analysis
- Chapter 4. Realist synthesis of interventions
- Chapter 5. Developing a candidate intervention
- Chapter 6. Optimising an evidence-informed intervention through expert events
- Chapter 7. Conclusions
- Main findings
- Wider considerations for evidence synthesis regarding behaviour change
- A behavioural focus for outcome measures
- Inclusive attempts to map intervention content
- Theory and mapping intervention content
- Limitations and strengths
- Assessment of factors relevant to the NHS and other parties
- Implications for service provision
- Suggested research priorities
- Acknowledgements
- References
- Appendix 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist
- Appendix 2. Literature search strategies: MEDLINE example
- Appendix 3. Excluded studies with rationale
- Appendix 4. Summary of context, mechanisms and outcomes extracted
- Appendix 5. Mock manual: ‘How to stay HIV negative’
- Appendix 6. Evidence informing the candidate intervention
- List of abbreviations
About the Series
Article history
The research reported in this issue of the journal was funded by the HTA programme as project number 13/77/03. The contractual start date was in August 2014. The draft report began editorial review in August 2015 and was accepted for publication in May 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.
Declared competing interests of authors
none
Last reviewed: August 2015; Accepted: May 2016.
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