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Social network strategy as a promising intervention to better reach key populations for promoting HIV prevention: a systematic review and meta-analysis
  1. Xing Yang1,
  2. Ting Fang1,
  3. Siam AI Mobarak2,
  4. Jing Wang3,
  5. Can Wang2,
  6. Shan Huang2,
  7. Li Jiang1,
  8. Xi Chen1,
  9. Hongzhan Li1,
  10. Weiwei Chang1,
  11. Lei Zhang4,5,
  12. Jieling Mo1,
  13. Chuanyi Ning1,6
  1. 1 Nursing College, Guangxi Medical University, Nanning, China
  2. 2 The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
  3. 3 Institute of Acute Communicable Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
  4. 4 China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
  5. 5 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  6. 6 Key Lab of AIDS Prevention and Treatment, BSL-3 Lab, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
  1. Correspondence to Dr. Chuanyi Ning, Nursing college, Guangxi Medical University, Nanning 530021, China; ningchuanyi{at}; Prof. Jieling Mo, Nursing College, Guangxi Medical University, Nanning 530021, China; gxnnm{at}


Introduction Key populations such as men who have sex with men (MSM), drug users and sex workers are at high risk of HIV infection, but they are marginalised and hidden. Social network strategy (SNS) is purposeful to use social networks to generate social influence, accelerate behaviour change and achieve desirable outcomes among individuals or communities and have been increasingly used for HIV interventions. This study aims to investigate the effects of SNS on HIV prevention among key populations.

Methods We searched six databases, including PubMed, Web of Science, Embase, Cochrane Library, ScienceDirect and Wiley for randomised controlled trials published between January 1999 and May 2019. Eligibility criteria included SNS conducted among key populations for HIV interventions, with a comparator group. Outcomes included changes in HIV high-risk behaviour, HIV seroconversion and other HIV outcomes. We used the risk ratio (RR) or mean difference with associated 95% confidence interval (CI) to assess the comparative efficacy between SNS and control methods on the selected outcomes. The GRADE system was used to assess the quality of evidence for the studies.

Results Of 2818 citations identified, 28 trails from 24 papers met the inclusion criteria. The results showed that SNS was associated with less unprotected intercourse (RR 0.79, 95% CI 0.72 to 0.86) and sex with multiple partners (0.46, 95% CI 0.33 to 0.65). Additionally, relative to the control methods, SNS significantly reduced HIV seroconversion (0.65, 95% CI 0.53 to 0.81), improved HIV testing uptake (1.11, 95% CI 1.07 to 1.15) and promoted participant retention (1.03, 95% CI 1.00 to 1.06) among key populations. The Grading of Recommendations Assessment, Development and Evaluation system showed that trails were of moderate quality.

Conclusions This review provides evidence that SNS can reach key populations who are currently not being reached by existing programmes and deliver HIV interventions through social networks, which decreases HIV sexual risk behaviour and HIV incidence and increases HIV testing uptake and participant retention.

Trial registration number CRD42019140533.

  • social network
  • key populations
  • HIV prevention
  • risk behavior
  • meta-analysis

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  • Handling editor Claudia S Estcourt

  • XY and TF contributed equally.

  • JM and CN contributed equally.

  • Contributors All authors contributed extensively to the work presented in this paper. JM and CN conceived the study. TF created and performed the literature search strategy, XY built the data extraction file, XY and TF performed the data extraction and JM and CN supervised the process. XY performed the results. All authors interpreted the data, and all the other authors contributed substantially to the writing and revising of the manuscript. All authors have read and approved the final version of the manuscript.

  • Funding This work was supported by funds from the National Natural Science Foundation of China (Grant No. 81803295, 81760602 and 8191101420), Thousand Talents Plan Professorship for Young Scholars (Grant No. 3111500001), Xi'an Jiaotong University Young Talent Support Program, Xi’an Jiaotong University Basic Research and Profession Grant (Grant No. xtr022019003).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.