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Meta-Analysis
. 2025 Sep 16;17(9):1247.
doi: 10.3390/v17091247.

Network Meta-Analytical Investigations of the Performance of HIV Combination Prevention Strategies for Indigenous Populations

Marcos Jessé Abrahão Silva  1 , Rebecca Lobato Marinho  1 , Daniele Melo Sardinha  1 , Diego Rafael Lima Batista  2 , Luiza Raquel Tapajós Figueira  1 , Tamires de Nazaré Soares  1 , Keitty Anne Silva Neves  1 , Aloma Mapinik Suruí  3 , Manuella Nunes Colaço  4 , Vinicius Dos Santos Peniche  5 , Ligia Regina Franco Sansigolo Kerr  6 , Sebastião Kauã de Sousa Bispo  7 , Ana Judith Pires Garcia  7 , Carl Kendall  8 , Luana Nepomuceno Gondim Costa Lima  7
Affiliations
Meta-Analysis

Network Meta-Analytical Investigations of the Performance of HIV Combination Prevention Strategies for Indigenous Populations

Marcos Jessé Abrahão Silva et al. Viruses. .

Abstract

Background: Indigenous populations worldwide face a disproportionate burden of HIV due to structural inequities, cultural marginalization, and limited access to health services. Despite growing recognition of the need for culturally adapted responses, the effectiveness of combination HIV prevention strategies in these communities remains underexplored.

Objectives: This study aimed to evaluate and compare the effectiveness of multiple HIV prevention strategies among Indigenous populations using a systematic review and network meta-analysis (NMA), to inform equity-oriented public health interventions.

Methods: Following PRISMA-NMA 2020 guidelines, a comprehensive literature search was conducted across four databases (PubMed, SciELO, LILACS, Science Direct) for quantitative studies published between January 2000 and June 2025. Eligible studies evaluated HIV prevention interventions among Indigenous populations and reported risk or odds ratios. A frequentist NMA model was used to calculate effect estimates (OR, 95% CI) and SUCRA rankings for seven types of interventions, combining biomedical, behavioral, and structural approaches.

Results: Four high-to-moderate quality studies enclosing 4523 participants were included. The most effective intervention was home-based counseling and testing for HIV, followed by medical consultation combined with HIV testing. Standalone testing, while effective, was significantly less impactful than when combined with culturally sensitive educational strategies. Information-only strategies showed the least efficacy. The SUCRA analysis ranked home-based testing highest (45.17%), highlighting the importance of decentralization, community participation, and intercultural mediation.

Conclusions: Culturally adapted combination prevention strategies-especially those integrating home-based testing and counseling-are more effective than isolated biomedical interventions in Indigenous populations. These findings reinforce the urgent need for participatory, context-driven public health responses that center Indigenous knowledge, reduce stigma, and expand equitable access to HIV care and prevention.

Keywords: HIV prevention; SUCRA; combination prevention; home-based counseling; indigenous populations; intercultural health; network meta-analysis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA Flowchart of the stages of selection and eligibility criteria processes on search, databases for this meta-analysis data material extraction.
Figure 2
Figure 2
Network Plot of Interventions Strategies for this Meta-analysis.
Figure 3
Figure 3
Forest Plot of Individual Analysis of Efficacy within Prevention HIV Strategies on this Meta-Analysis [28,29,30,31].
Figure 4
Figure 4
Forest Plot showing Measures Effects with 95% Confidence Intervals for HIV prevention interventions in Indigenous populations with Testing for HIV as a reference factor for comparisons.
See this image and copyright information in PMC

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