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HIV-Alcohol Risk Reduction Interventions in Sub-Saharan Africa: A Systematic Review of the Literature and Recommendations for a Way Forward

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Abstract

Sub-Saharan Africa bears 69 % of the global burden of HIV, and strong evidence indicates an association between alcohol consumption, HIV risk behavior, and HIV incidence. However, characteristics of efficacious HIV-alcohol risk reduction interventions are not well known. The purpose of this systematic review is to summarize the characteristics and synthesize the findings of HIV-alcohol risk reduction interventions implemented in the region and reported in peer-reviewed journals. Of 644 citations screened, 19 met the inclusion criteria for this review. A discussion of methodological challenges, research gaps, and recommendations for future interventions is included. Relatively few interventions were found, and evidence is mixed about the efficacy of HIV-alcohol risk reduction interventions. There is a need to further integrate HIV-alcohol risk reduction components into HIV prevention programming and to document results from such integration. Additionally, research on larger scale, multi-level interventions is needed to identify effective HIV-alcohol risk reduction strategies.

Resumen

El África subsahariana tiene el 69 % de la carga mundial de VIH, y una fuerte evidencia indica que el consumo de alcohol, la conducta de riesgo del VIH, y la incidencia del VIH están asociados. Sin embargo, las características de intervenciones eficaces para la reducción de riesgo de VIH-alcohol no son bien conocidas. El propósito de esta revisión sistemática es resumir las características de las intervenciones de reducción de riesgo de VIH-alcohol que se han implementado en la región y reportado en revistas científicas y sintetizar los hallazgos. De 644 estudios, 19 cumplieron los criterios para ser incluidos en este artículo. En este estudio analizamos los desafíos metodológicos, lagunas en la investigación y ofrecemos recomendaciones para futuras intervenciones. Encontramos que relativamente pocas intervenciones han sido evaluadas, y la evidencia sobre la eficacia de las intervenciones de reducción de riesgo de VIH-alcohol no es clara ya que solo algunos estudios reportan efectos los cuales generalmente se disipan en el largo plazo. Existe la necesidad de una mayor integración de componentes de reducción de riesgo de VIH-alcohol en los programas de prevención del VIH y de documentar los resultados de dicha integración. Además, se necesita investigación sobre intervenciones de mayor escala y en varios niveles para determinar estrategias eficaces en la reducción de toma de riesgos relacionados con el consumo de alcohol y el VIH.

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Acknowledgments

We would like to thank Drs. Deanna Kerrigan and Susan Sherman for reviewing earlier drafts of this paper and providing invaluable guidance and Librarian Ms. Victoria Riese for assistance with the search strategy. M.A. Carrasco was supported by the National Institute of Allergy and Infectious Disease (T32 AI050056-12).

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  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway Street, Baltimore, MD, 21205, USA

    Maria A. Carrasco, Marissa B. Esser, Alicia Sparks & Michelle R. Kaufman

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  1. Maria A. Carrasco
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Correspondence to Maria A. Carrasco.

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Carrasco, M.A., Esser, M.B., Sparks, A. et al. HIV-Alcohol Risk Reduction Interventions in Sub-Saharan Africa: A Systematic Review of the Literature and Recommendations for a Way Forward. AIDS Behav 20, 484–503 (2016). https://doi.org/10.1007/s10461-015-1233-5

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