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Sex Transm Infect 2005;81:386-393 doi:10.1136/sti.2004.013714
  • Prevention

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

  1. D J Ward1,
  2. B Rowe1,
  3. H Pattison2,
  4. R S Taylor3,
  5. K W Radcliffe4
  1. 1Public Health, South Worcestershire Primary Care Trust, Worcester, UK
  2. 2Department of Psychology, Aston University, Birmingham, UK
  3. 3Public Health and Epidemiology, The University of Birmingham, Birmingham, UK
  4. 4Genitourinary Medicine, Heart of Birmingham Teaching Primary Care Trust, Birmingham, UK
  1. Correspondence to:
 Derek J Ward
 Birmingham and Solihull Health Protection Unit, Bartholomew House, 142 Hagley Road, Edgbaston, Birmingham B16 9PA, UK; derek.wardhobtpct.nhs.uk
  • Accepted 4 February 2005

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.

Footnotes

  • DJW and BR are employed on the West Midlands Public Health Higher Specialist Training Scheme. At the time of undertaking this study, both were working at South Worcestershire Primary Care Trust. HP is employed by the School of Life and Health Sciences at Aston University, while RST is employed by the University of Birmingham and funded by the West Midlands Regional Public Health levy. KWR is employed by the Heart of Birmingham Teaching Primary Care Trust and works as a consultant in genitourinary medicine at the Whittall Street Clinic.

  • Funding: All contributors undertook this review as part of their normal employment and did not receive specific funding for this study, which was carried out independently of their employers.

  • Competing interest: The authors have no competing interests.

  • Ethical approval: Ethical approval was not required for this study.

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