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. 2005 Oct;81(5):386–393. doi: 10.1136/sti.2004.013714

Reducing the risk of sexually transmitted infections in genitourinary medicine clinic patients: a systematic review and meta-analysis of behavioural interventions

D Ward 1, B Rowe 1, H Pattison 1, R Taylor 1, K Radcliffe 1
PMCID: PMC1745046  PMID: 16199737

Abstract

Objectives: Are behavioural interventions effective in reducing the rate of sexually transmitted infections (STIs) among genitourinary medicine (GUM) clinic patients?

Design: Systematic review and meta-analysis of published articles.

Data sources: Medline, CINAHL, Embase, PsychINFO, Applied Social Sciences Index and Abstracts, Cochrane Library Controlled Clinical Trials Register, National Research Register (1966 to January 2004).

Review methods: Randomised controlled trials of behavioural interventions in sexual health clinic patients were included if they reported change to STI rates or self reported sexual behaviour. Trial quality was assessed using the Jadad score and results pooled using random effects meta-analyses where outcomes were consistent across studies.

Results: 14 trials were included; 12 based in the United States. Experimental interventions were heterogeneous and most control interventions were more structured than typical UK care. Eight trials reported data on laboratory confirmed infections, of which four observed a greater reduction in their intervention groups (in two cases this result was statistically significant, p<0.05). Seven trials reported consistent condom use, of which six observed a greater increase among their intervention subjects. Results for other measures of sexual behaviour were inconsistent. Success in reducing STIs was related to trial quality, use of social cognition models, and formative research in the target population. However, effectiveness was not related to intervention format or length.

Conclusions: While results were heterogeneous, several trials observed reductions in STI rates. The most effective interventions were developed through extensive formative research. These findings should encourage further research in the United Kingdom where new approaches to preventing STIs are urgently required.

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Selected References

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  1. Bonell C., Imrie J. Behavioural interventions to prevent HIV infection: rapid evolution, increasing rigour, moderate success. Br Med Bull. 2001;58:155–170. doi: 10.1093/bmb/58.1.155. [DOI] [PubMed] [Google Scholar]
  2. Boyer C. B., Barrett D. C., Peterman T. A., Bolan G. Sexually transmitted disease (STD) and HIV risk in heterosexual adults attending a public STD clinic: evaluation of a randomized controlled behavioral risk-reduction intervention trial. AIDS. 1997 Mar;11(3):359–367. doi: 10.1097/00002030-199703110-00014. [DOI] [PubMed] [Google Scholar]
  3. Branson B. M., Peterman T. A., Cannon R. O., Ransom R., Zaidi A. A. Group counseling to prevent sexually transmitted disease and HIV: a randomized controlled trial. Sex Transm Dis. 1998 Nov;25(10):553–560. doi: 10.1097/00007435-199811000-00011. [DOI] [PubMed] [Google Scholar]
  4. Elwy A. Rani, Hart Graham J., Hawkes Sarah, Petticrew Mark. Effectiveness of interventions to prevent sexually transmitted infections and human immunodeficiency virus in heterosexual men: a systematic review. Arch Intern Med. 2002 Sep 9;162(16):1818–1830. doi: 10.1001/archinte.162.16.1818. [DOI] [PubMed] [Google Scholar]
  5. Follmann D., Elliott P., Suh I., Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992 Jul;45(7):769–773. doi: 10.1016/0895-4356(92)90054-q. [DOI] [PubMed] [Google Scholar]
  6. Hughes G., Andrews N., Catchpole M., Goldman M., Forsyth-Benson D., Bond M., Myers A. Investigation of the increased incidence of gonorrhoea diagnosed in genitourinary medicine clinics in England, 1994-6. Sex Transm Infect. 2000 Feb;76(1):18–24. doi: 10.1136/sti.76.1.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Imrie J., Stephenson J. M., Cowan F. M., Wanigaratne S., Billington A. J., Copas A. J., French L., French P. D., Johnson A. M., Behavioural Intervention in Gay Men Project Study Group A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial. BMJ. 2001 Jun 16;322(7300):1451–1456. doi: 10.1136/bmj.322.7300.1451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Jadad A. R., Moore R. A., Carroll D., Jenkinson C., Reynolds D. J., Gavaghan D. J., McQuay H. J. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996 Feb;17(1):1–12. doi: 10.1016/0197-2456(95)00134-4. [DOI] [PubMed] [Google Scholar]
  9. Johnson A. M., Mercer C. H., Erens B., Copas A. J., McManus S., Wellings K., Fenton K. A., Korovessis C., Macdowall W., Nanchahal K. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet. 2001 Dec 1;358(9296):1835–1842. doi: 10.1016/S0140-6736(01)06883-0. [DOI] [PubMed] [Google Scholar]
  10. Kalichman S. C., Cherry C., Browne-Sperling F. Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for inner-city African American men. J Consult Clin Psychol. 1999 Dec;67(6):959–966. doi: 10.1037//0022-006x.67.6.959. [DOI] [PubMed] [Google Scholar]
  11. Kamb M. L., Fishbein M., Douglas J. M., Jr, Rhodes F., Rogers J., Bolan G., Zenilman J., Hoxworth T., Malotte C. K., Iatesta M. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. JAMA. 1998 Oct 7;280(13):1161–1167. doi: 10.1001/jama.280.13.1161. [DOI] [PubMed] [Google Scholar]
  12. Maher Julie E., Peterman Thomas A., Osewe Patrick L., Odusanya Sandra, Scerba John R. Evaluation of a community-based organization's intervention to reduce the incidence of sexually transmitted diseases: a randomized, controlled trial. South Med J. 2003 Mar;96(3):248–253. doi: 10.1097/01.SMJ.0000054605.31081.07. [DOI] [PubMed] [Google Scholar]
  13. O'Leary A., Ambrose T. K., Raffaelli M., Maibach E., Jemmott L. S., Jemmott J. B., 3rd, Labouvie E., Celentano D. Effects of an HIV risk reduction project on sexual risk behavior of low-income STD patients. AIDS Educ Prev. 1998 Dec;10(6):483–492. [PubMed] [Google Scholar]
  14. Orr D. P., Langefeld C. D., Katz B. P., Caine V. A. Behavioral intervention to increase condom use among high-risk female adolescents. J Pediatr. 1996 Feb;128(2):288–295. doi: 10.1016/s0022-3476(96)70413-4. [DOI] [PubMed] [Google Scholar]
  15. Pinkerton S. D., Layde P. M., DiFranceisco W., Chesson H. W., NIMH Multisite HIV Prevention Trial Group All STDs are not created equal: an analysis of the differential effects of sexual behaviour changes on different STDs. Int J STD AIDS. 2003 May;14(5):320–328. doi: 10.1258/095646203321605521. [DOI] [PubMed] [Google Scholar]
  16. Shain R. N., Piper J. M., Newton E. R., Perdue S. T., Ramos R., Champion J. D., Guerra F. A. A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N Engl J Med. 1999 Jan 14;340(2):93–100. doi: 10.1056/NEJM199901143400203. [DOI] [PubMed] [Google Scholar]
  17. Shrier L. A., Ancheta R., Goodman E., Chiou V. M., Lyden M. R., Emans S. J. Randomized controlled trial of a safer sex intervention for high-risk adolescent girls. Arch Pediatr Adolesc Med. 2001 Jan;155(1):73–79. doi: 10.1001/archpedi.155.1.73. [DOI] [PubMed] [Google Scholar]
  18. Solomon M. Z., DeJong W. Preventing AIDS and other STDs through condom promotion: a patient education intervention. Am J Public Health. 1989 Apr;79(4):453–458. doi: 10.2105/ajph.79.4.453. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Stephenson J. M., Imrie J., Sutton S. R. Rigorous trials of sexual behaviour interventions in STD/HIV prevention: what can we learn from them? AIDS. 2000;14 (Suppl 3):S115–S124. [PubMed] [Google Scholar]
  20. Stephenson J., Imrie J. Why do we need randomised controlled trials to assess behavioural interventions? BMJ. 1998 Feb 21;316(7131):611–613. doi: 10.1136/bmj.316.7131.611. [DOI] [PMC free article] [PubMed] [Google Scholar]

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Supplementary Materials

[Web-only appendices]
straninf_81_5_386__index.html (1.8KB, html)
straninf_81_5_386__1.pdf (63.7KB, pdf)
straninf_81_5_386__2.pdf (14.3KB, pdf)
straninf_81_5_386__3.pdf (14.2KB, pdf)

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