{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:13:29Z","timestamp":1792790009081,"version":"4.5.0"},"reference-count":61,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bolsa CAPES Financial Process Code n\u00b0 001"},{"name":"CNPq Process Code n\u00b0 405858\/2024-8"},{"name":"Bolsa EXP-B of CNPq"},{"name":"Bolsa CNPq ATP-A"},{"name":"Evandro Chagas Institute (IEC)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>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\u2014especially those integrating home-based testing and counseling\u2014are 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.<\/jats:p>","DOI":"10.3390\/v17091247","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T11:19:31Z","timestamp":1758021571000},"page":"1247","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Network Meta-Analytical Investigations of the Performance of HIV Combination Prevention Strategies for Indigenous Populations"],"prefix":"10.3390","volume":"17","author":[{"given":"Marcos Jess\u00e9 Abrah\u00e3o","family":"Silva","sequence":"first","affiliation":[{"name":"Postgraduate Program in Parasite Biology in the Amazon (PPGBPA), State University of Par\u00e1 (UEPA), Bel\u00e9m 66087-662, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1294-4837","authenticated-orcid":false,"given":"Rebecca Lobato","family":"Marinho","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Parasite Biology in the Amazon (PPGBPA), State University of Par\u00e1 (UEPA), Bel\u00e9m 66087-662, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2650-2354","authenticated-orcid":false,"given":"Daniele Melo","family":"Sardinha","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Parasite Biology in the Amazon (PPGBPA), State University of Par\u00e1 (UEPA), Bel\u00e9m 66087-662, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego Rafael Lima","family":"Batista","sequence":"additional","affiliation":[{"name":"School of Health Sciences, State University of the Amazonas (UEA), Manaus 69065-001, AM, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiza Raquel Tapaj\u00f3s","family":"Figueira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Parasite Biology in the Amazon (PPGBPA), State University of Par\u00e1 (UEPA), Bel\u00e9m 66087-662, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamires de Nazar\u00e9","family":"Soares","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Parasite Biology in the Amazon (PPGBPA), State University of Par\u00e1 (UEPA), Bel\u00e9m 66087-662, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keitty Anne Silva","family":"Neves","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Parasite Biology in the Amazon (PPGBPA), State University of Par\u00e1 (UEPA), Bel\u00e9m 66087-662, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aloma Mapinik","family":"Suru\u00ed","sequence":"additional","affiliation":[{"name":"Special Indigenous Health District-Vilhena Indigenous Health Secretariat-SESAI, Porto Velho 76804-444, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuella Nunes","family":"Cola\u00e7o","sequence":"additional","affiliation":[{"name":"Par\u00e1 State Secretariat for Indigenous Peoples (SEPI), Bel\u00e9m 66015-040, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinicius dos Santos","family":"Peniche","sequence":"additional","affiliation":[{"name":"Law Department, Dam\u00e1sio University, S\u00e3o Paulo 01503-001, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4941-408X","authenticated-orcid":false,"given":"Ligia Regina Franco Sansigolo","family":"Kerr","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Ceara (UFC), Fortaleza 60430-160, CE, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebasti\u00e3o Kau\u00e3 de Sousa","family":"Bispo","sequence":"additional","affiliation":[{"name":"Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2613-7219","authenticated-orcid":false,"given":"Ana Judith Pires","family":"Garcia","sequence":"additional","affiliation":[{"name":"Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-4333","authenticated-orcid":false,"given":"Carl","family":"Kendall","sequence":"additional","affiliation":[{"name":"Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana Nepomuceno Gondim Costa","family":"Lima","sequence":"additional","affiliation":[{"name":"Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.clindermatol.2024.02.001","article-title":"The Global Burden of HIV","volume":"42","author":"Payagala","year":"2024","journal-title":"Clin. 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