Abstract：
For people at risk of HIV infection, pre-exposure prophylaxis (PrEP) can reduce the risk of infection in anticipation of exposure to HIV. The effectiveness of PrEP relies upon a user\'s adherence to their PrEP regimen. We sought to assess the effect of PrEP adherence interventions compared to usual care or another intervention for people at risk of HIV. We searched electronic databases from 2010 onwards for randomized controlled trials (RCTs) involving persons at risk of HIV randomized to an adherence promoting intervention vs usual care or another intervention. We used network meta-analyses to compare PrEP adherence for all participant populations. Certainty of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). 21 trials (N = 4917) were included in qualitative analysis (19 in network meta-analyses (N = 4101)). HIV self-testing interventions with adherence feedback elements improved adherence compared to usual care (risk ratio (RR): 1.83, 95%CI 1.19, 2.82). In contrast, HIV self-testing alone was inferior to HIV self-testing with adherence feedback (RR: 0.58, 95%CI 0.37-0.92). Reminders alone also were inferior to HIV self-testing with adherence feedback on adherence (RR: 0.53, 95%CI 0.34-0.84) and had similar effects on adherence as usual care (RR: 0.98, 95%CI: 0.86-1.11). Interventions with only one component were inferior for adherence than those with two components (RR: 0.74, 95%CI 0.62-0.88) and those with three components (RR: 0.78, 95%CI 0.65-0.93). The certainty of evidence was moderate for HIV self-testing plus adherence feedback and interventions with two or three components. When designing future PrEP adherence interventions, we recommend strategies with more than one but no more than three components.
摘要：
对于有感染艾滋病毒风险的人，暴露前预防（PrEP）可以降低预期暴露于HIV的感染风险。PrEP的有效性依赖于用户对其PrEP方案的坚持。我们试图评估PrEP依从性干预措施与常规护理或其他干预措施相比对HIV风险人群的影响。从2010年起，我们在电子数据库中搜索了随机对照试验（RCT），该试验涉及有HIV风险的人，随机分为依从性促进干预措施与常规护理或其他干预措施。我们使用网络荟萃分析来比较所有参与者人群的PrEP依从性。使用网络荟萃分析（CINeMA）中的置信度评估证据的确定性。21项试验(N=4917)纳入定性分析(19项网络荟萃分析(N=4101))。与常规护理相比，具有依从性反馈元素的HIV自检干预措施改善了依从性（风险比（RR）：1.83，95CI1.19，2.82）。相比之下,单独的HIV自检不如具有依从性反馈的HIV自检（RR：0.58，95CI0.37-0.92）。单独的提醒也不如HIV自我检测对依从性的依从性反馈（RR：0.53，95CI0.34-0.84），并且对依从性的影响与常规护理相似（RR：0.98，95CI：0.86-1.11）。仅使用一种成分的干预在依从性上比使用两种成分的干预（RR：0.74，95CI0.62-0.88）和使用三种成分的干预（RR：0.78，95CI0.65-0.93）差。对于HIV自我检测加上依从性反馈和具有两个或三个组成部分的干预措施，证据的确定性中等。在设计未来的PrEP依从性干预措施时，我们建议使用一个以上但不超过三个组件的策略。
