Background
Methods
Search methods for identification of studies
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#1 AND #2 AND #3 NOT #4 AND #5
Eligibility criteria
Data collection and analysis
Assessment of risk of bias in included studies
Level of Evidence | Description |
---|---|
1 = Strong | Systematic review/meta-analysis of RCTs with consistent findings; high-quality individual RCT |
2 = Medium | Systematic review/meta-analysis of lower-quality clinical trials or of studies with inconsistent findings; lower quality clinical trial; cohort study; case–control study |
3 = Weak | Consensus guidelines; usual practice; expert opinion; case series |
Rating | Description |
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1 = Good | Evidence includes consistent results from well-designed well-conducted studies in representative populations that directly assess effects on health outcomes |
2 = Fair | Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes |
3 = Poor | Evidence is based on consensus, usual practice, opinion, or case series. Additionally evidence is insufficient to fully assess the effects on health outcomes because of limited number, or power of studies, important flaws in design or conduct, gaps in the chain of evidence, or lack of information on importance on the key health outcomes |
Grade | Definition |
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High | We are very confident that the estimate of effect lies close to the true effect for this outcome. The body of evidence has few or no deficiencies. We believe that the findings are stable (i.e., another study would not change the conclusions). |
Moderate | We are moderately confident that the estimate of effect lies close to the true effect for this outcome. The body of evidence has some deficiencies. We believe that the findings are likely to be stable, but some doubt remains. |
Low | We have limited confidence that the estimate of effect lies close to the true effect for this outcome. The body of evidence has major or numerous deficiencies (or both). We believe that additional evidence is needed before concluding either that the findings are stable or that the estimate of effect is close to the true effect. |
Insufficient | We have no evidence, we are unable to estimate an effect, or we have no confidence in the estimate of effect for this outcome. No evidence is available or the body of evidence has unacceptable deficiencies, precluding us from reaching a conclusion. |
Statistical assessment
Results
Study selection
Study characteristics
Author, year, location | Study design & setting | Study duration in months | Intervention group | Control group | Intervention facilitator | Group size for intervention | Time per session and total session | Intervention period (wks) | Follow up month | Age mean (SD) | Male | Female | TG | Outcome and tools |
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Berger et al, 2008 [24], Switzerland | RCT, multicenter, clinic | 9 | Cognitive behavioral stress management (CBSB) | Standard care | 1. Cognitive behavioral psychotherapist 2. Postgraduate psychotherapy trainee | 4 to 10 | 2 h, 12 session | 12 | 1,6,12 | 44.1 (10.1) | 89 | 15 | QoL: MOS-HIV, Anxiety: HADS-A, Depression: HADS-D, CD4, HIV1-RNA, adherence to ART | |
Blank et al, 2014 [25], USA | Longitudinal randomized trial, community | 54 | Preventing AIDS through Health for HIV positive persons (PATH+), Psycho-education along with pillboxex and beeping watches | Standard care | Advanced practice nurse | 12 to 20/visit | 1visit/week | 48 | 3, 6, 12, 24 | 43.0 (7.25) | 128 | 110 | QoL: SF-12, Viral load, CD4 | |
Bormann et al, 2006 [26], USA | RCT, mixed repeated measure, clinic | 12 | Mantram intervention | Attention group | Psychiatric mental health nurse | 8 to 15 | 1.5 h, 6 session, with phone call 4 time | 10 | 1.1, 2.2, 5.2 | 42.9 (6.84) | 75 | 18 | Qol: Q-LES-Q, Anxiety: STAI, Depression: CES-D, Distress: HIV- IES, Stress: PSS, Anger: STAI-SF, Spiritual well being: FACIT-SpEx | |
Brown et al, 2014 [27], USA | RCT, clinic (secondary analysis) | System CHANGETM-HIV intervention, self-management, spiritual and optimism | Standard care and symptom management materials | Trained female interventionist | 8 to 10 | 1 h, 10 session | 10 | 2.2 | 48.4 (6.9) | 25 | 18 | Spirituality: SWBS, Optimism: LOTR | ||
Cade et al, 2010 [28], USA | RCT, prospective, clinic | Yoga intervention | Standard care | Certified yoga instructor | Individual and group | 1 h, 40–60 session | 20 | 5 | 45.0 (7.9) | 10 | 50 | QoL: MOS-SF-36, Nutritant intake | ||
Chhatre et al, 2013 [29], USA | RCT, single blinded; community | 6 | Transcendental meditation ™ | Healthy eating (HE) education | Certified instructor | Individual and group | 2 h, 32 session & 20 min twice a day | 24 | 6 | 49.9 (5.8) | 18 | 4 | QoL: MOS-SF-36, Depression: CESD, Stress: PSS, HIV-QoL: FAHI, Quality of well being: QWB-SA, Hormonal outcome | |
Duncan et al, 2012 [30], USA | Randomized, wait-list controlled trial; clinic | 6 | Mindfulness-based stress reduction (MBSR) | Standard care (WLC) | Experienced MBSR teacher | Individual and group | 2.5–3 h, 8 session & 1 h home practice | 8 | 3, 6 | 48.0 (7.9) | 64 | 12 | Depression: BDI, Stress: PSS, Positive & negative affects schedule, Mindfulness: FFMQ, ART adherence, Side effect checklist | |
Eller et al, 2013 [31], South Africa, Puerto Rico, USA | Multisite RCT, clinic & community | 13 | HIV/AIDS symptom management manual self-care symptom management strategies | Nutritional care and support for PLHIV | Research nurse | Individual | 30 min., 1 session | 2 | 43.1 (9.6) | 126 | 93 | 3 | Depressive symptom: CES-D | |
Fillipas et al, 2006 [32], Australia | RCT, single blinded; clinic and community | 27 | Supervised aerobic and resistance exercise program | Unsupervised walking program and attended a monthly group forum | Physiotherapist | 8 to 10 | 1 h, 48 session | 24 | 6 | 43.5 (8.8) | 40 | QoL: MOS-HIV health survery-35, Self-efficacy: GSES, CD4, Viral load, cardiovascular fitness | ||
Galantino et al, 2005 [33], USA | RCT, clinic | 12 | Tai Chi (TC) and aerobic exercise (EX) | Standard care | Licensed physical therapist and aerobic instructor | 13 | 1 h, 16 session | 8 | 2 | 51 | QoL: MOS-HIV, Spiritual well being or psychological change: POMS | |||
Gayner et al, 2012 [34], Canada | RCT, clinic | 36 | Mindfulness-based stress reduction (MBSR) | Standard care | Psychiatrist | Individual and group (14 to 18) | 3 h, 8 session, 1 h homework/day | 8 | 2, 6 | 43.8 (7.0) | 117 (Gay men) | Anxiety: HADS, Depression: HADS, Positive & negative affect schedule, mindfullness scale: TMS, Impact of event scale, Distress: IES | ||
Goujard et al, 2003 [35], France | RCT, multicenter, clinic | 24 | Education | Standard care | Physician and nurse | Individual | 1 h, 3 session | 48 | 6, 12, 18 | 40.5 | 261 | 65 | QoL: HIV-46, Adherence to ART: PMAQ7, CD4 | |
Jones et al, 2007 [36], USA | 2X2 factorial design; clinic & community | Cognitive behavioral stress management (CBSM+) and healthier lifestyle | Group and individual (Factorial groups) | Therapist | Individual and group | 2.5 h, 6 session | 12 | 3, 6 | 41.0 (8.0) | 177 | Coping with stress: COPE, adherence to ART: ACTG | |||
Lechner et al, 2003 [37], USA | clinic & community | Group based Cognitive behavioral stress management (CBSM+) and expressive supportive therapy | Individual psychoeducational condition | Psychologist | 10 | 2 h, 10 session | 10 | 3 | 39.7 (7.1) | 330 | QoL: MOS-HIV-30 | |||
Li et al, 2010 [38], Thailand | RCT, clinic | 24 | Behavioral intervention | Standard care | Group | 13 session | 13 | 6, 12 | 37.4 (6.6) | 167 | 340 | QoL: MOS-HIV, Depression, Disclosure, Internalized shame, Social support, Family functioning | ||
Maharaj et al, 2011 [39], South Africa | Randomized controlled prospective longitudinal, clinic | 24 | Rehabilitation exercise | Heat therapy & reading magazine | 1 h, 12 session | 12 | 3 | 33.6 (9.6) | 34 | 18 | QoL: MOS-SF-36 | |||
McCain et al, 2003 [40], USA | RCT, community | Cognitive behavioral stress management (CBSM) and social support group (SSG) | Wait list | Mental health nurse | 6 to 10 | 1.5 h, 8 session | 8 | 2, 6 | 39.4 | 119 | 29 | QoL: FACT-G, Psychological distress: IES, Perceived stress: DIS, Coping patterns: DIS, Social support: SPS, viral load, CD | ||
Miles et al, 2003 [41], USA | Intervention, clinic | 36 | HIV self care symptom management | Standard care | Registered nurse | Individual | 6 visit | 12 | 1, 6 | 37.0 (8.4) | 109 | Qol: MOS-HIV-35, Depression: CESD, Profile mood states: POMS, Stigma: Demi, HIV worry | ||
Molassiotis et al, 2002 [42], China | Intervention, clinic | Cognitive behavioral therapy (CBT) and peer support counseling (PSC) | Standard care | Qualified nurse experienced in counseling | 3 to 6 | 2 h, 12 session | 12 | 3, 6 | 39.1 (10.8) | 32 | 3 | QoL: WHOQOLBRF, Depression, Anger, Uncertainty in illness: MUIS, POMS | ||
Mutimura et al, 2008 [43], Rwanda | RCT, clinic | 12 | Body fat redistribution (BFR) and exercise training (EXS) | BFR but noexercise training (nEXS) | 1.5 h, 72 session | 24 | 6 | 37.7 (6.2) | 40 | 60 | QoL: WHOQOL-HIV, BMI | |||
Ogalha et al, 2011 [44], Brazil | RCT, clinic | 6 | Physical activities (aerobic, resisted and stretching) and counseling | Counseling | Nutrition specialist | 11 | 1 h, 72 session | 24 | 6 | 43.0 (9.4) | 34 | 29 | QoL: MOS-SF-36, BMI, CD4, Nutritional status | |
Proeschold-Bell et al, 2010 [45], USA | RCT, clinic | 24 | Health information exchange | Standard care | 98 | 12, 24 | 42.4 (7.7) | 145 | 109 | QoL: MOS-SF-36, viral load, CD4, adherence to ART | ||||
Ruiz et al, 2010 [46], Spain | Randomized, concurrent, follow up study, clinic | 12 | Treated by health professional (physician or pharmacist with extensive knowledge) | Treated by peer | Trained therapist | 1 h, 4 visit | 24 | 2, 4, 6 | 41.16 (8.16) | 176 | 64 | QoL: MOS-HIV-35, Adherence to ART: SMAQ, Psychological distress: GHQ-12, Social support: Duke-UNC-11, Viral load | ||
Sikkema et al, 2005 [47], USA | Community | 22 | Cognitive behavioral bereavement coping group intervention | Individual psychotherapy upon request | Clinical psychologist, Clinical social workers, Nurse | 6 to 8 | 1.5 h, 12 session | 12 | 3 | 40.3 (7.0) | 150 | 85 | QoL: FACT-G (FAHI), Physical health status | |
Tam et al, 2012 [48], Vietnam | RCT, cluster; clinic | 13 | Peer support and standard care | Standard care | Trained HIV infected people | Individual | 56 visit | 48 | 12 | 155 | 73 | QoL: WHOQOL-HIVBREF | ||
Wang et al, 2010 [49], China | RCT; clinic | 8 | Nursing intervention (home visit and telephone calls) | Standard care | Nurse | Individual | 4 session | 32 | 8 | 36.7 (5.6) | 97 | 19 | QoL: WHOQOLBREF, Depression: SDS, Adherence to ART: CPCRA | |
Webel, 2010 [50], USA | RCT, clinic & community | 12 | Pee based symptom management and positive self-management program | HIV symptom management strategies | Trained peer leader | 10 | 2 h, 7 session | 7 | 3 | 47.0 (8.6) | 74 | 14 | QoL: HIV/AIDS TQoL, Adherence to ART: ACTG, Symptom intensity | |
Wu et al, 2006 [51], USA | RCT, clinic | 24 | Disease management assistance system (DMAS) and education | Adherence counseling | Individual | 30 min., 6 session, daily reminder | 24 | 6 | 38.5 (6.9) | 36 | 26 | QoL: MOS-HIV, Depression: CESD, activity of daily living: IADLs, Role functioning: SF-36, Adherence: eDEM, CD4, Viral load |
Intervention characteristics
Study quality or risk of bias
ID | Internal validity | External validity | Quality of evidence for individual studies |
---|---|---|---|
Berger et al, 2008 [24] | Fair | Fair | Medium |
Blank et al, 2014 [25] | Poor | Fair | Medium |
Bormann et al, 2006 [26] | Poor | Fair | Medium |
Brown et al, 2014 [27] | Fair | Fair | Medium |
Cade et al, 2010 [28] | Poor | Poor | Weak |
Chhatre et al, 2013 [29] | Fair | Poor | Weak |
Duncan et al, 2012 [30] | Fair | Poor | Medium |
Eller et al, 2013 [31] | Poor | Poor | Weak |
Fillipas et al, 2006 [32] | Fair | Fair | Medium |
Galantino et al, 2005 [33] | Poor | Poor | Medium |
Gayner et al, 2012 [34] | Fair | Fair | Medium |
Goujard et al, 2003 [35] | Poor | Poor | Medium |
Jones et al, 2007 [36] | Poor | Poor | Medium |
Lechner et al, 2003 [37] | Poor | Poor | Medium |
Li et al, 2010 [38] | Fair | Good | Strong |
Maharaj et al, 2011 [39] | Poor | Poor | Weak |
McCain et al, 2003 [40] | Poor | Poor | Medium |
Miles et al, 2003 [41] | Poor | Poor | Medium |
Molassiotis et al, 2002 [42] | Poor | Fair | Medium |
Mutimura et al, 2008 [43] | Fair | Poor | Medium |
Ogalha et al, 2011 [44] | Poor | Poor | Medium |
Proeschold-Bell et al, 2010 [45] | Poor | Poor | Medium |
Ruiz et al, 2010 [46] | Fair | Fair | Medium |
Sikkema et al, 2005 [47] | Fair | Good | Medium |
Tam et al, 2012 [48] | Fair | Fair | Medium |
Wang et al, 2010 [49] | Poor | Poor | Weak |
Webel, 2010 [50] | Fair | Poor | Medium |
Wu et al, 2006 [51] | Poor | Fair | Medium |