Review of Impact of Risk Reduction Sessions on Sexual Behaviors in HIV Prevention Trials: Insights from Africa

Over the past two decades, numerous HIV prevention trials have targeted thousands of young African women, aiming not only to reduce transmissions through biomedical interventions but also to promote safe sexual practices through intensive risk reduction sessions. The primary objective of this study was to review the impact of risk reduction sessions in HIV prevention trials conducted in Africa. We assessed changes in sexual behaviors among women enrolled in various biomedical intervention trials across the African region using both visual and quantitative evaluations. Meta-analysis techniques were used to estimate overall odds ratios. In a sub-group analysis, we also used semiparametric regression models to capture important features of the associations between sexual behaviors across the study visits with minimal statistical assumptions. Key time points were identified using the "zero-crossing" technique. Overall summary odds ratio (OR) for condom use in last sex was estimated as 2.21 (95% CI 2.06, 2.36). In our sub-group analysis, women who reported multiple sexual partners declined (adjusted odds ratios (aORs) range: 0.61-0.67) while condom use in last sex improved over time (aORs ranged from 2.22-to-2.60); 347(57%) women HIV seroconverted within the first 6-months which was the most crucial time point with substantial reductions in risky behaviors. This review highlights that the gradual cumulative effect of risk reduction sessions, rather than an immediate substantial impact, may have significant implications in clinical research settings. Effective and sustainable risk reduction programs should include biological components such as pre-exposure prophylaxis (PrEP) to reduce HIV transmission.