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Publications

Journal Article Ahead of print

PubMed: 42894420 DOI: 10.1080/09540121.2026.2748795

Comparison of combined HIV prevention interventions for prisoners: a network meta-analysis.

AIDS Care

Authors: Marcos Jessé Abrahão Silva, Rebecca Lobato Marinho, Daniele Melo Sardinha, Caroliny Soares Silva, Thiago Pinto Brasil, Paulo Rafael Cardoso de Sousa, Natália Da Silva Oliveira, Thiago Augusto Ferreira Dos Anjos, Diego Rafael Lima Batista, Iago Sergio De Castro Farias, Renato César Gomes Cunha, Leandro Rodrigo Pereira de Matos, Ligia Regina Franco Sansigolo Kerr, Carl Kendall, Francisco Marto Leal Pinheiro Júnior, Everaldina Cordeiro Dos Santos, Maria Elias Sarmento da Silveira, Henrique Barros, Luana Nepomuceno Gondim Costa Lima

Affiliations

  • Postgraduate Program in Parasitic Biology in the Amazon (PPGBPA), State University of Pará (UEPA), Belém, Brazil.
  • Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, Brazil.
  • Bacteriology and Myology Section (SABMI), Evandro Chagas Institute (IEC), Ananindeua, Brazil.
  • Escola Superior de Ciências da Saúde, State University of the Amazonas (UEA), Manaus, Brazil.
  • Nursing Department, Federal University of Pará (UFPA), Belém, Brazil.
  • Department of Social Services, Estácio de Sá Faculty, Belém, Brazil.
  • Social and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
  • Research and Development, FioCruz Ceará, Fortaleza, Brazil.
  • High School Department, Escola Ministro Alcides Carneiro, Ananindeua, Brazil.
  • Public Health Department, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.

Abstract

HIV prevalence among incarcerated populations is three to four times higher than in the general population, driven by overcrowding, stigma, limited healthcare access, and high-risk behaviors. This systematic review and Bayesian network meta-analysis, conducted according to PRISMA-NMA 2020 guidelines, evaluated combined HIV prevention strategies in prisons. Six randomized or quasi-experimental studies published between 2014 and 2020, including 2.445 incarcerated participants, were analyzed. Interventions were compared directly and indirectly using a hierarchical model and ranked by SUCRA. Retention in care combined with antiretroviral therapy (ART) adherence was the most effective strategy (SUCRA = 84.9%), followed by linkage or reengagement in care plus ART adherence (80.9%) and education with partner reduction (73.2%). Behavioral-only interventions, such as condom distribution and counseling, showed moderate-to-low efficacy (approximately 35-37%), while structural interventions, including change teams, produced heterogeneous results often constrained by implementation barriers. Overall heterogeneity was moderate. The findings indicate that biomedical strategies ensuring ART retention and adherence should be the cornerstone of HIV prevention in prisons, with behavioral and structural interventions serving as complementary components of integrated, multi-component prevention packages.

MeSH

Prisoners, Acquired Immunodeficiency Syndrome, Network Meta-Analysis, Prisons, Health Promotion