Interventions to reduce risky sexual behaviour in gay men: systematic review and intervention development

Abstract

Background: Guidance relating to individual level behaviour change interventions in HIV prevention is limited. New interventions are needed particularly within gay men. Objective(s): Through systematic review and meta synthesis of supplemental analyses to identify effective components within interventions and to develop a candidate intervention. Data sources: All major electronic databases were searched between January 2000 and December 2014. Review methods: Interventions were examined using the behaviour change technique taxonomy, theory coding assessment and mode of delivery. Supplemental analyses used 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 using the theoretical domains framework and normalisation process theory. Results: Overall, trials included in this review (n=10) reported positive findings suggesting behavioural change interventions are effective. Exploratory meta-analysis showed a statistically significant reduction in risk behaviours (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. In addition, the realist review highlighted the importance of affective dimensions to intervention delivery/receipt, and the analysis of sequential components highlighted the importance of the participant's journey through the intervention (and the patterning of BCTS). Conclusions: Limited evidence suggests behaviour change interventions are effective. UK experts found the candidate intervention acceptable and provided ways of optimising the candidate intervention.