Abstract

HIV prevention in young people in Sub-Saharan Africa: a systematic review and update of the evidence

Presented by Aoife M Doyle (United Kingdom).

A.M. Doyle, S. Napierala Mavedzenge, D.A. Ross

London School of Hygiene & Tropical Medicine, Epidemiology and Population Health, London, United Kingdom

Background: Evidence-based recommendations should guide efforts towards the UN goals on HIV/AIDS in young people. In 2006, the WHO Steady, Ready, Go! (SRG) review series provided such recommendations. Results from four recent major trials provoked this updated review and recommendations.
Methods: We used the SRG systematic review approach and synthesised recent evidence (Jan 05-Dec 08) with that covered by the first SRG review (1990-2005). We reviewed the effectiveness of interventions to improve reported sexual behaviour and reduce STIs and pregnancies for interventions implemented in schools, health services, and/or geographically-defined communities in sub-Saharan Africa.
Results: Screening nearly 1200 citations published in 2005-2008 identified 23 interventions meeting the inclusion criteria. Only five studies measured biological outcomes. Only one intervention type received a “Go!” recommendation; adult-led, curriculum-based interventions in schools, based on of their potential to reduce risky reported sexual behaviours. There was sufficiently strong evidence to give a “Ready” recommendation to health service interventions training service providers, making changes in the clinic, and interventions in the community with or without the involvement of other sectors, based on evidence of increased use of health services. Community-wide interventions in geographically-defined communities were also given a “Ready” recommendation.
Conclusions: The large number of new studies since the first SRG review highlights the recent activity in research on HIV prevention in young people. However, the quality of most evaluations remained weak, and cost-effectiveness data were usually lacking. Multi-component interventions, especially those targeting the wider community, may be the most effective. From studies measuring biological markers of sexual activity, it appears that the interventions evaluated to date may not be enough to reduce HIV. There is a need to explore ways of supplementing such interventions to impact HIV incidence in young people.