Caitlin E. Kennedy, PhD, MPH

New research shows there are some limitations to counseling behavioral interventions for patients with HIV, sexually transmitted infections (STI), and viral hepatitis.¹

A team, led by Caitlin E. Kennedy, PhD, MPH, Department of International Health, Johns Hopkins Bloomberg School of Public Health, looked at various measures, including effectiveness, values, preferences, and cost on counseling behavioral interventions within key populations.

Vulnerable Populations

Certain populations, including sex workers, men who have sex with men, people who inject drugs, people in prisons and other closed settings, and trans and gender diverse individuals, are often disproportionately affected by HIV, sexually transmitted infections, and viral hepatitis.

While counseling behavioral interventions are commonly used, it is unknown whether they had an impact on HIV, STI, or viral hepatitis acquisition.

The aim of the study was to inform new World Health Organization (WHO) guidelines.

In the study, investigators searched various databases for studies published between January 2010 and December 2022. The studies included in the effectiveness review were randomized controlled trials (RCTs) with HIV/STI/VH incidence outcomes, as well as secondary review outcomes of unprotected sex, needle/syringe sharing and mortality were captured if studies also included primary review outcomes.

The investigators assessed the risk of bias using Cochrane Collaboration tools and generated pooled risk ratios (RR) through random effects meta-analysis. The findings were summarized in GRADE evidence profiles.

Overall, the final analysis included 9 studies on effectiveness, 2 on values and preferences, and 2 cost articles.

After conducting a meta-analysis of 6 randomized-controlled trials, the investigators did not find a statistically significant effect of counselling behavioral interventions on HIV incidence (n = 1280; combined risk ratio [RR], 0.70; 95% confidence interval [CI], 0.41–1.20) or STI incidence (n = 3783; RR, 0.99; 95% CI, 0.74–1.31).

However, there was 1 randomized-controlled trials involving 139 participants that showed possible effects on hepatitis C virus incidence.

There was no effect on secondary review outcomes of unprotected sex (7 randomized-controlled trials; n = 1811; RR, 0.82; 95% CI, 0.66–1.02) and needle/syringe sharing (2 randomized-controlled trials; n = 564; RR, 0.72; 95% CI, 0.32–1.63).

The results show a moderate certainty on the lack of effect across outcomes and 2 values and preferences studies found participants enjoyed specific counseling behavioral interventions.

A pair of cost analysis showed reasonable intervention costs.

“While there may be other benefits, the choice to provide counselling behavioural interventions for key populations should be made with an understanding of the potential limitations on incidence outcomes,” the authors wrote.

References:

Kennedy, C. E., Yeh, P. T., Verster, A., Luhmann, N., Konath, N. M., Mello, M. B., Baggaley, R., & Macdonald, V. (2023). Counselling behavioural interventions for HIV, STI and viral hepatitis among key populations: A systematic review of effectiveness, values and preferences, and cost studies. Journal of the International AIDS Society, 26(5). https://doi.org/10.1002/jia2.26085