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Onaisi R, Joseph JP, Castera P, Pontgratz C. Sexual risk behaviour reduction interventions in primary care in Organization of Economic Cooperation and Development countries. A systematic review. Fam Pract 2022; 39:762-770. [PMID: 34668006 DOI: 10.1093/fampra/cmab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sexually transmitted infections are a major public health issue, both in France and worldwide. Primary healthcare professionals play a key role in sexual health and prevention, but few take on this subject. Prevention strategies are diverse, thus risk reduction strategies focussing on behavioural changes are still needed. PURPOSE We conducted a systematic review to analyse risk reduction interventions focussing on behavioural change in OECD countries in primary healthcare settings to help develop a prevention tool easy to apply in primary care. METHODS We searched for English- or French-language controlled trials in PubMed, Cochrane Library, Scopus, PsycINFO, PsycArticle, PBSC, SocINDEX, Google Scholar, and CAIRN, supplemented with the bibliographies of previous systematic reviews. Thirty controlled, randomized, or nonrandomized trials were included in the systematic review. We did not conduct any meta-analysis due to the diversity of populations, outcomes and study designs. RESULTS There are efficient interventions in primary healthcare settings for reducing sexual risk behaviours and/or incident STI. Their efficiency seems to grow with the length and intensity of the intervention. Most interventions target only young, high-risk patients, and their long-term impact is uncertain. Most included studies had an overall risk of bias estimated as high or with some concerns. CONCLUSIONS Some tools could be used in primary care, with possible efficiency though results are difficult to generalize, and value should be assessed in daily practice. Future research should also focus on older population given the epidemiological evolutions, but also lower-risk population to target all patients seen in primary care settings.
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Affiliation(s)
- Racha Onaisi
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Jean-Philippe Joseph
- Department of General Practice, University of Bordeaux, Bordeaux, France.,CIC 1401-EC (Clinical Epidemiology), Bordeaux, France.,Inserm U1219, Univ. Bordeaux, Bordeaux, France
| | - Philippe Castera
- Department of General Practice, University of Bordeaux, Bordeaux, France
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Ng JYS, Chan RKW, Chio MTW, Lim RBT, Koh D, Wong ML. An Abstinence and Safer Sex Intervention for Adolescents Attending the Public Sexually Transmitted Infection Clinic in Singapore. J Adolesc Health 2018; 62:737-746. [PMID: 29661642 DOI: 10.1016/j.jadohealth.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/20/2017] [Accepted: 12/27/2017] [Indexed: 10/17/2022]
Abstract
PURPOSE The objective of this study was to evaluate the efficacy of a behavioral intervention in increasing secondary abstinence and safer sex among heterosexually active adolescents aged 16-19 years. METHODS This was a randomized controlled trial conducted at the only national sexually transmitted infection clinic in Singapore. The intervention focused on information giving, motivation, and skills building to abstain or practice safer sex. The outcome measures were self-reported secondary abstinence, consistent condom use, and keeping to one partner in the past 6 months over a 12-month period. We recruited 688 adolescents, with 337 participants receiving intervention and 351 receiving standard care (control). RESULTS At the 12-month follow-up, 187 (56%) intervention participants and 189 (54%) control participants were retained. Over the 12-month period, the intervention had a significant effect on secondary abstinence in adolescent boys (42% vs. 27%, adjusted risk ratio [aRR] 1.80, 95% confidence interval [CI] 1.29-2.34) but not in adolescent girls (21% vs. 24%, aRR 1.10, 95% CI .68-1.66). Consistent condom use was higher among intervention adolescent girls than control adolescent girls (40% vs. 20%, aRR 2.01, 95% CI 1.32-2.82), but this effect was not evident in adolescent boys (51% vs. 43%, aRR 1.27, 95% CI .78-1.88). Intervention effect on keeping to one partner was evident in both adolescent boys (76% vs. 45%, aRR 1.35, 95% CI 1.06-1.50) and adolescent girls (79% vs. 65%, aRR 1.20, 95% CI 1.02-1.23). CONCLUSIONS An intervention targeting adolescents in a clinical care setting did achieve an increase in secondary abstinence in adolescent boys, consistent condom use in adolescent girls, and keeping to one partner in both genders at 1-year assessment.
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Affiliation(s)
- Junice Yi Siu Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Roy Kum Wah Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of STI Control, National Skin Centre, Ministry of Health, Singapore
| | - Martin Tze-Wei Chio
- Department of STI Control, National Skin Centre, Ministry of Health, Singapore
| | - Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - David Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; PAPRSB Institute of Health Sciences, University Brunei Darussalam, Brunei
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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3
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Wong ML, Y S Ng J, K W Chan R, T W Chio M, B T Lim R, Koh D. Randomized controlled trial of abstinence and safer sex intervention for adolescents in Singapore: 6-month follow-up. HEALTH EDUCATION RESEARCH 2017; 32:233-243. [PMID: 28472284 DOI: 10.1093/her/cyx040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Abstract
We assessed the efficacy of an individual-based behavioral intervention on sexually transmitted infections' (STI) risk-reduction behaviors in Singapore. A randomized controlled trial of a behavioral intervention compared to usual care was conducted on sexually active heterosexual adolescents aged 16-19 years attending the only public STI clinic. The intervention included two on-site skills-based sessions targeting individual, relational and environmental influences on sexual behaviors, followed by online support. Participants were assessed at baseline and 6-month follow-up. Primary outcomes were self-reported abstinence, number of partners and consistent condom use for vaginal sex. We recruited 337 adolescents to the intervention and 351 to usual care (controls). Fifty-nine percent of intervention participants and 53% of controls completed follow-up. Young men [adjusted risk ratio (RR) 2.03; 95% CI, 1.25-3.30], but not young women, in the intervention were more likely than controls to report secondary abstinence. More non-abstinent young women in the intervention than controls kept to one partner (adjusted RR, 1.25; 95% CI, 1.04-1.50) compared to no differences in young men. There was no intervention effect on consistent condom use in both genders. Skill-based intervention can promote abstinence in young men and keeping to one partner in young women in a clinic setting.
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Affiliation(s)
- Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Junice Y S Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Roy K W Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of STI Control, National Skin Centre, Singapore
| | | | - Raymond B T Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - David Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
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Toskin I, Cooper B, Troussier T, Klugman B, Kulier R, Chandra-Mouli V, Temmerman M. WHO guideline for brief sexuality-related communication: implications for STI/HIV policy and practice. REPRODUCTIVE HEALTH MATTERS 2017; 23:177-84. [PMID: 26719009 DOI: 10.1016/j.rhm.2015.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/06/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Abstract
Brief sexuality-related communication (BSC) aims to identify current and potential sexual concerns and motivate those at risk to change their sexual behaviour or maintain safe sexual behaviour. BSC in primary health care can range from 5 to 60 minutes and takes into account biological, psychological and social dimensions of sexual health and wellbeing. It focuses on opportunistic rather than systematic or continuous communication and can be used in conjunction with already established prevention programs. The informational and motivational techniques of BSC enable health care providers to communicate more effectively with their patients, encouraging them to take steps to avoid HIV and sexually transmitted infections. The WHO Department of Reproductive Health and Research, following a review and assessment of existing evidence with regards to BSC, has recently published the guideline on Brief Sexuality-Related Communication: Recommendations for a Public Health Approach.
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Affiliation(s)
- Igor Toskin
- Scientist, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Bergen Cooper
- Consultant, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Barbara Klugman
- Visiting Professor, School of Public Health, Faculty of Health Sciences, University of the Witwatersrandd
| | | | | | - Marleen Temmerman
- Director, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Marcell AV, Gibbs S, Lehmann HP. Brief condom interventions targeting males in clinical settings: a meta-analysis. Contraception 2015; 93:153-63. [PMID: 26410175 DOI: 10.1016/j.contraception.2015.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/30/2015] [Accepted: 09/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to assess the effectiveness of brief clinic-based condom skills interventions that target males. STUDY DESIGN We searched PubMed, Cumulative Index of Nursing and Allied Health Literature and PsychInfo for studies published from January 1980 through September 2014, using relevant search terms. We included studies if interventions taught about condoms lasting 60 min or shorter, used randomized or quasi-experimental design, were conducted in a clinical setting and targeted males. Two investigators sequentially reviewed abstracts. We abstracted and reviewed data from 16 studies that met the selection criteria. Where outcomes were poolable, we conducted meta-analyses using a random-effects model and I(2) index to assess heterogeneity. Outcome measures included condom knowledge, attitudes, behaviors, sexually transmitted infections (STIs)/human immunodeficiency virus and unintended pregnancy. RESULTS Across studies, teaching about condoms was nested within sexual risk reduction curricula. Most interventions were one on one and conducted in STI clinics. Pooled analyses indicated that intervention receipt was associated with increases in percent of sex acts with condoms (standardized mean difference=0.29 [0.18, 0.41]; 0.19 [0.06, 0.33]) and reductions in STIs at 12-month follow-up or longer {odds ratio (OR)=0.82 [95% confidence interval: 0.67, 0.99]}. One study assessed unintended pregnancy and did not find an intervention effect. CONCLUSIONS Study findings hold promise for considering brief condom skills interventions in clinical settings that can result in improvements in males' condom behaviors and possibly biological outcomes.
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Affiliation(s)
- Arik V Marcell
- Johns Hopkins School of Medicine, 200 N. Wolfe Street, Baltimore, MD 21287, USA; Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Susannah Gibbs
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Harold P Lehmann
- Johns Hopkins School of Medicine, 200 N. Wolfe Street, Baltimore, MD 21287, USA.
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Cooper B, Toskin I, Kulier R, Allen T, Hawkes S. Brief sexuality communication--a behavioural intervention to advance sexually transmitted infection/HIV prevention: a systematic review. BJOG 2014; 121 Suppl 5:92-103. [PMID: 25335846 DOI: 10.1111/1471-0528.12877] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Throughout the last decade substantial research has been undertaken to develop evidence-based behaviour change interventions for sexual health promotion. Primary care could provide an opportunistic entry for brief sexual health communication. OBJECTIVES We conducted a systematic review to explore opportunistic sexual and reproductive health services for sexual health communication delivered at primary health care level. SEARCH STRATEGY We searched for studies on PubMed, ProQuest, CINAHL, Jstor, Scopus/Science Direct, Cochrane database of systematic reviews, EBSCO, CINAHL, PsychoInfo, and Web of Knowledge. Both published and unpublished articles were reviewed. SELECTION CRITERIA All randomised controlled trials and controlled clinical trials were included. Participants of all ages, from adolescence onwards were included. Brief (10-60 minutes) interventions including some aspect of communication on sexual health issues were included. DATA COLLECTION AND ANALYSIS Data were extracted by two reviewers independently using a standardised form. Interventions differed from each other, hence meta-analysis was not performed, and results are presented individually. MAIN RESULTS A total of 247 articles were selected for full-text evaluation, 31 of which were included. Sexually transmitted infections (STIs)/HIV were less often reported in the intervention group compared with the control group. Condom use was higher in most studies in the intervention group. Numbers of sexual partners and unprotected sexual intercourse were lower in the intervention groups. CONCLUSIONS There is evidence that brief counselling interventions have some effect in the reduction and prevention of STIs/HIV. Some questions could not be answered, such as the effect over time and in different settings and population groups.
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Affiliation(s)
- B Cooper
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JSG, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312:390-409. [PMID: 25038358 PMCID: PMC6309682 DOI: 10.1001/jama.2014.7999] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
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Affiliation(s)
| | | | - David R Holtgrave
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil
| | - N Kumarasamy
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
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Eaton LA, Huedo-Medina TB, Kalichman SC, Pellowski JA, Sagherian MJ, Warren M, Popat AR, Johnson BT. Meta-analysis of single-session behavioral interventions to prevent sexually transmitted infections: implications for bundling prevention packages. Am J Public Health 2012; 102:e34-44. [PMID: 22994247 DOI: 10.2105/ajph.2012.300968] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Evidence-based, single-session behavioral interventions are urgently needed for preventing the spread of HIV and other sexually transmitted infections (STIs). To estimate the efficacy of single-session, behavioral interventions for STI prevention, we collected data from 29 single-session interventions (20 studies; n = 52 465) with an STI outcome. Infection with an STI was 35% less likely (odds ratio = 0.65; 95% confidence interval = 0.55-0.77) among intervention group participants than among control group participants. Single-session interventions offer considerable benefits in terms of disease prevention and create minimal burden for both the patient and the provider. Brief and effective STI prevention interventions are a valuable tool and can be readily adapted to bolster the benefits of biomedical technologies focusing on the prevention of HIV and other STIs.
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Affiliation(s)
- Lisa A Eaton
- University of Connecticut, CHIP, 2006 Hillside Rd, Storrs, CT 06268-1248, USA.
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9
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Scott-Sheldon LAJ, Huedo-Medina TB, Warren MR, Johnson BT, Carey MP. Efficacy of behavioral interventions to increase condom use and reduce sexually transmitted infections: a meta-analysis, 1991 to 2010. J Acquir Immune Defic Syndr 2011; 58:489-98. [PMID: 22083038 PMCID: PMC5729925 DOI: 10.1097/qai.0b013e31823554d7] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In the absence of an effective HIV vaccine, safer sexual practices are necessary to avert new infections. Therefore, we examined the efficacy of behavioral interventions to increase condom use and reduce sexually transmitted infections (STIs), including HIV. DESIGN Studies that examined a behavioral intervention focusing on reducing sexual risk, used a randomized controlled trial or a quasi-experimental design with a comparison condition, and provided needed information to calculate effect sizes for condom use and any type of STI, including HIV. METHODS Studies were retrieved from electronic databases (eg, PubMed, PsycINFO) and reference sections of relevant papers. Forty-two studies with 67 separate interventions (N = 40,665; M age = 26 years; 68% women; 59% Black) were included. Independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed-effects and random-effects models, were calculated. Potential moderators of intervention efficacy were assessed. RESULTS Compared with controls, intervention participants increased their condom use [d+ = 0.17, 95% confidence interval (CI) = 0.04, 0.29; k = 67], had fewer incident STIs (d+ = 0.16, 95% CI = 0.04, 0.29; k = 62), including HIV (d+ = 0.46, 95% CI = 0.13, 0.79; k = 13). Sample (eg, ethnicity) and intervention features (eg, skills training) moderated the efficacy of the intervention. CONCLUSIONS Behavioral interventions reduce sexual risk behavior and avert STIs and HIV. Translation and widespread dissemination of effective behavioral interventions are needed.
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Lazarus JV, Sihvonen-Riemenschneider H, Laukamm-Josten U, Wong F, Liljestrand J. Systematic review of interventions to prevent the spread of sexually transmitted infections, including HIV, among young people in Europe. Croat Med J 2010; 51:74-84. [PMID: 20162748 DOI: 10.3325/cmj.2010.51.74] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union. METHODS For this systematic review, we examined interventions that aimed at STI risk reduction and health promotion conducted in schools, clinics, and in the community for reported effectiveness (in changing sexual behavior and/or knowledge) between 1995 and 2005. We also reviewed study design and intervention methodology to discover how these factors affected the results, and we compiled a list of characteristics associated with successful and unsuccessful programs. Studies were eligible if they employed a randomized control design or intervention-only design that examined change over time and measured behavioral, biologic, or certain psychosocial outcomes. RESULTS Of the 19 studies that satisfied our review criteria, 11 reported improvements in the sexual health knowledge and/or attitudes of young people. Ten of the 19 studies aimed to change sexual risk behavior and 3 studies reported a significant reduction in a specific aspect of sexual risk behavior. Two of the interventions that led to behavioral change were peer-led and the other was teacher-led. Only 1 of the 8 randomized controlled trials reported any statistically significant change in sexual behavior, and then only for young females. CONCLUSION The young people studied were more accepting of peer-led than teacher-led interventions. Peer-led interventions were also more successful in improving sexual knowledge, though there was no clear difference in their effectiveness in changing behavior. The improvement in sexual health knowledge does not necessarily lead to behavioral change. While knowledge may help improve health-seeking behavior, additional interventions are needed to reduce STIs among young people.
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Affiliation(s)
- Jeffrey V Lazarus
- Copenhagen School of Global Health, Copenhagen University, Copenhagen, Denmark.
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11
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Lau JT, Tsui HY, Cheng S, Pang M. A randomized controlled trial to evaluate the relative efficacy of adding voluntary counseling and testing (VCT) to information dissemination in reducing HIV-related risk behaviors among Hong Kong male cross-border truck drivers. AIDS Care 2009; 22:17-28. [DOI: 10.1080/09540120903012619] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joseph T.F. Lau
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
| | - Hi Yi Tsui
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
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Vivancos R, Abubakar I, Hunter PR. Sex, drugs and sexually transmitted infections in British university students. Int J STD AIDS 2008; 19:370-7. [DOI: 10.1258/ijsa.2007.007176] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary: Understanding predisposing factors for sexually transmitted infections (STIs) in young adults may identify targets for public health interventions. We conducted a cross-sectional web-based survey of university students’ sexual attitudes, behaviours and lifestyles and self-reported rates of STI. A total of 827 students responded, 22.4% had two or more sexual partners in the previous year with inconsistent condom use and the lifetime prevalence of STIs was 9.6%. Factors associated with a diagnosis of STI were increasing age and number of sexual partners ever, female gender (adjusted odds ratio [AOR] 2.70, 95% confidence interval [CI] 1.31, 5.56) and use of crack (AOR 10.45, 95% CI 1.46, 75.16). For female students, these were increasing age and number of partners ever, whereas for male students having sex with other men (bisexual AOR 4.8, 95% CI 1.02, 22.595, homosexual AOR 17.66, 95% CI 3.03, 103.04) and use of crack (AOR 32.24, 95% CI 3.33, 312.08). Multiple partners and recreational drug use may predict incidence of STI. Prevention strategies need to aim at reducing risk behaviour across various activities.
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Affiliation(s)
- R Vivancos
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - I Abubakar
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - P R Hunter
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
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Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychol Bull 2006; 132:249-68. [PMID: 16536643 DOI: 10.1037/0033-2909.132.2.249] [Citation(s) in RCA: 1569] [Impact Index Per Article: 87.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Numerous theories in social and health psychology assume that intentions cause behaviors. However, most tests of the intention- behavior relation involve correlational studies that preclude causal inferences. In order to determine whether changes in behavioral intention engender behavior change, participants should be assigned randomly to a treatment that significantly increases the strength of respective intentions relative to a control condition, and differences in subsequent behavior should be compared. The present research obtained 47 experimental tests of intention-behavior relations that satisfied these criteria. Meta-analysis showed that a medium-to-large change in intention (d = 0.66) leads to a small-to-medium change in behavior (d = 0.36). The review also identified several conceptual factors, methodological features, and intervention characteristics that moderate intention-behavior consistency.
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Affiliation(s)
- Thomas L Webb
- School of Psychological Sciences, The University of Manchester, Manchester, United Kingdom.
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Durantini MR, Albarracín D, Mitchell AL, Earl AN, Gillette JC. Conceptualizing the Influence of Social Agents of Behavior Change: A Meta-Analysis of the Effectiveness of HIV-Prevention Interventionists for Different Groups. Psychol Bull 2006; 132:212-48. [PMID: 16536642 PMCID: PMC4803282 DOI: 10.1037/0033-2909.132.2.212] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds.
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Affiliation(s)
- Marta R Durantini
- Department of Psychology, University of Florida, Gainesville, FL 32608, USA.
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Albarracín D, Gillette JC, Earl AN, Glasman LR, Durantini MR, Ho MH. A test of major assumptions about behavior change: a comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychol Bull 2005. [PMID: 16351327 DOI: 10.1037/0033–2909.131.6.856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts.
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Affiliation(s)
- Dolores Albarracín
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA.
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Albarracín D, Gillette JC, Earl AN, Glasman LR, Durantini MR, Ho MH. A test of major assumptions about behavior change: a comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychol Bull 2005; 131:856-97. [PMID: 16351327 PMCID: PMC2713787 DOI: 10.1037/0033-2909.131.6.856] [Citation(s) in RCA: 437] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts.
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Affiliation(s)
- Dolores Albarracín
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA.
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Boekeloo BO, Griffin MA. Review of Clinical Trials Testing the Effectiveness of Clinician Intervention Approaches to Prevent Sexually Transmitted Diseases in Adolescent Outpatients. Curr Pediatr Rev 2005; 1:173-185. [PMID: 25657616 PMCID: PMC4315618 DOI: 10.2174/1573396054065457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Identify approaches for improving clinician provision of sexually transmitted diseases (STDs) prevention services among outpatient adolescents. METHODS Reviewed all peer-reviewed, published clinical trials identified through computerized searches (MEDLINE, PsychINFO) evaluating STD prevention services to outpatient adolescents by clinicians. RESULTS Five trials were identified examining changes in clinician provision of STD prevention services. Two of these trials resulted in adolescent self-reported risk reduction but neither of these trials effectively demonstrated reductions in objectively measured STD incidence. Nine clinical trials were identified that compared clinician with non-clinician provision of STD prevention services. Four of these trials resulted in adolescent self-reported risk reduction, and one of these trials demonstrated a reduction in objectively measured STD incidence. CONCLUSIONS Trials indicate that improvement in outpatient adolescent STD incidence is possible with non-clinicians as interventionists, and perhaps clinicians as interventionists if clinicians are supported by other educational resources. Opportunities for personalized, interactive adolescent education appears key to intervention success. The clinician role that is tested in most trials is confined to a single brief encounter with little attention to: development of clinician skills, quality of psychosexual risk assessment and tailoring to meet individual adolescent need, systems-level resources and supports, the parental role, or the impact of incorporating prevention into an ongoing adolescent-clinician relationship.
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Affiliation(s)
- Bradley O Boekeloo
- University of Maryland, Department of Public and Community Health, College Park, Maryland 20742, 301-405-8546, FAX: 301-314-6598
| | - Melinda A Griffin
- University of Maryland, Department of Public and Community Health, College Park, Maryland 20742, 301-405-8546, FAX: 301-314-6598
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Manhart LE, Holmes KK. Randomized controlled trials of individual-level, population-level, and multilevel interventions for preventing sexually transmitted infections: what has worked? J Infect Dis 2005; 191 Suppl 1:S7-24. [PMID: 15627233 DOI: 10.1086/425275] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Previous reviews of interventions to prevent sexually transmitted infections (STIs) focused mostly on human immunodeficiency virus (HIV) infection. We reviewed trials of interventions to prevent sexual transmission of any STI, employing a multilevel perspective. METHODS We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and recent unpublished presentations through 2003, to identify randomized controlled trials of preventive STI interventions having systematic, objective measurement of STI outcomes. We classified trials according to intervention target and level of randomization (individual, group, or community); impact target (acquisition, transmission, or complications of STI); and primary intervention modality. RESULTS Of 83 trials identified, 41 met inclusion criteria, including trials of 28 individual-level, 9 group-level, and 4 community-level interventions. Among individual- and group-level interventions, 32 targeted acquisition, 4 targeted transmission, and 1 targeted complications of STI. The 4 intervention modalities most often used included behavior change (12 studies), vaccination (7 studies), use of topical microbicides (10 studies), and prophylactic, curative, or suppressive therapy (10 studies). Community-level interventions had multiple impact targets, and 2 interventions used multiple modalities. Only 1 intervention showed efficacy against sexual transmission of HIV, but 22 (53.7%) showed effectiveness against other STIs. CONCLUSION Although many interventions have been found to be effective against STIs, few have been replicated, widely implemented, or carefully evaluated for effectiveness in other settings.
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Affiliation(s)
- Lisa E Manhart
- Departments of Medicine and Epidemiology and Center for AIDS and STD, University of Washington, Seattle, WA 98104, USA
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Baker SA, Beadnell B, Stoner S, Morrison DM, Gordon J, Collier C, Knox K, Wickizer L, Stielstra S. Skills training versus health education to prevent STDs/HIV in heterosexual women: a randomized controlled trial utilizing biological outcomes. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2003; 15:1-14. [PMID: 12627740 DOI: 10.1521/aeap.15.1.1.23845] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We compared the effectiveness of two different 16-session group interventions for reducing new STD infection among heterosexual women. Two hundred twenty-nine at-risk heterosexual women were randomly assigned to skills training (ST) based on the relapse prevention model or health education (HE). Participants were monitored during the year following intervention for STD acquisition, self-reports of sexual behavior, and risk reduction skills. Participants in the ST intervention were significantly less likely to be diagnosed with a STD in the year following intervention and demonstrated superior risk reduction skills at 12-month follow-up. Both conditions showed statistically significant reductions in self reports of risky sexual behavior following intervention and at 12-month follow-up. In this sample, the ST intervention was superior to HE for reducing STD acquisition.
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Affiliation(s)
- Sharon A Baker
- University of Washington, School of Social Work, Seattle 98105, USA.
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Pinkerton SD, Layde PM. Using sexually transmitted disease incidence as a surrogate marker for HIV incidence in prevention trials: a modeling study. Sex Transm Dis 2002; 29:298-307. [PMID: 11984448 DOI: 10.1097/00007435-200205000-00009] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Because many of the sexual behaviors that place individuals at risk of acquiring HIV are the same as those that place them at risk for other sexually transmitted diseases (STDs), researchers and policymakers have called for the use of non-HIV STDs as surrogate markers for HIV infection. GOALS This study examined the epidemiologic conditions under which changes in STD incidence are associated with changes in HIV incidence. STUDY DESIGN A mathematical model of HIV/STD transmission was applied to empirical data from a large HIV prevention intervention. The association between participants' HIV infection risk reduction scores and their STD risk reduction scores was measured with use of the Pearson product-moment correlation. The authors examined how the strength of association varied across different epidemiologic parameters and heterosexual behaviors. RESULTS Moderate to strong associations were noted when the infectivity of the STD was similar to the infectivity of HIV. The association was attenuated for larger STD infectivity values. The prevalence of STD infection was a less important determinant of the strength of association. Stronger associations were obtained when the number of sex partners was large or the number of sex acts was small. CONCLUSIONS Easily transmitted STDs, such as gonorrhea, are unsuitable for general use as surrogate markers for HIV infection. Hepatitis B, syphilis, and chlamydial infection have more promising epidemiologic profiles. Careful studies of STD infectivity are needed to aid in the identification of potential marker STDs.
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Affiliation(s)
- Steven D Pinkerton
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Milwaukee, Wisconsin 53202, USA.
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Imrie J, Fenton KA, Billington A. HIV prevention and homosexual men: should we be optimistic about the new millennium? Sex Transm Infect 1999; 75:369-71. [PMID: 10754934 PMCID: PMC1758264 DOI: 10.1136/sti.75.6.369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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