Systematic review: intervening after a HIV- test

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative HIV test in men who have sex with men (MSM): systematic review and intervention development

PI: Prof Paul Flowers, (GCU)
Funder: NIHR HTA

Background: MSM experience significant inequalities in health and wellbeing. They are the group at highest risk of acquiring HIV within the United Kingdom. Guidance relating to both HIV prevention in general and individual level behaviour change interventions in particular is very limited.

Objective(s): To conduct an evidence synthesis of the clinical effectiveness of behavioural change interventions to reduce risky sexual behaviour after a negative HIV test in MSM. To identify effective components within interventions in reducing HIV risky 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 were searched between January 2000 and December 2014.

Review methods: systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique taxonomy, theory coding assessment, mode of delivery and proximity to testing event. Data were summarised in narrative review and meta-analysis were carried out where appropriate. Supplemental analyses for the development of the candidate intervention focussed upon post hoc realist review methods, 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 acceptability and optimisation.

Results: Overall, trials included in this review (n=10) reported positive findings and suggest individual level behavioural change interventions are effective in reducing key HIV risk related behaviours. However, there were 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% CI 0.62, 0.91). Additional stratified analyses suggested effectiveness may be enhanced through face-to-face, immediately post-test delivery, theory based content and behaviour change techniques drawn from ‘goals and planning’ and ‘identity’ groups. All evidence collated within the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways the candidate intervention could be optimised to enhance UK implementation.

Limitations: There was a limited number of primary studies, all from outside the UK, and within them considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must be treated with caution, and may only be used for hypotheses generating. In terms of assessing intervention content and delivery, findings are limited by uncertain intervention fidelity, an overreliance upon published papers rather than intervention manuals, and the use of innovative methodologies.

Conclusions: The limited evidence regarding the effectiveness of behaviour change interventions does suggest they are effective in changing behaviour associated with HIV transmission. However, there are uncertainties around the generalisability of these findings to the UK setting. 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 which clearly articulate intervention content and demonstrate intervention fidelity.

Study registration: The study was registered as PROSPERO no.CRD42014009500

Funding details: The National Institute for Health Research Health Technology Assessment programme.

Final report can be found HERE